The Board of Trustees of the University of Illinois

NPI #1972541902 in Rockford, Illinois

Provider Information

NPI Number: 1972541902
Entity Type: Organization
Organization Name: The Board of Trustees of the University of Illinois
Primary Specialty: Pediatrics
Enumeration Date: Jun 3, 2006
Last Updated: Aug 18, 2022

Practice Location

Address: 2350 N ROCKTON AVE STE 204
City: Rockford
State: Illinois
ZIP Code: 61103-3669
Phone: (815) 395-8812

Authorized Official

Name: LOREEN SUE DIDIER
Title: CREDENTIALING SPECIALIST
Phone: (815) 395-5861

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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