University of Illinois

NPI #1619948411 in Peoria, Illinois

Provider Information

NPI Number: 1619948411
Entity Type: Organization
Organization Name: University of Illinois
Primary Specialty: Pediatrics - Developmental - Behavioral Pediatrics
Enumeration Date: Jan 30, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: REGIONAL DEVELOPMENT CENTER
Address 2: 507 E ARMSTRONG
City: Peoria
State: Illinois
ZIP Code: 61603
Phone: (309) 681-6960

Authorized Official

Name: WILLIAM R NICHAOLAS, PHD
Title: EXECUTIVE DIRECTOR OF MSP
Phone: (312) 413-0573

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics - Developmental - Behavioral Pediatrics — Developmental - Behavioral Pediatrics	2080P0006X	Primary

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