Provider Demographics
NPI:1538615836
Name:UNIVERSITY OF ILLINOIS HOSPITAL
Entity type:Organization
Organization Name:UNIVERSITY OF ILLINOIS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-996-0241
Mailing Address - Street 1:1463 W WINNEMAC AVE
Mailing Address - Street 2:UNIT 2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2800
Mailing Address - Country:US
Mailing Address - Phone:586-201-0815
Mailing Address - Fax:
Practice Address - Street 1:1463 W WINNEMAC AVE
Practice Address - Street 2:UNIT 2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:586-201-0815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014067281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital