Provider Demographics
NPI:1992925580
Name:ILLINOIS DEPARTMENT OF PUBLIC HEALTH
Entity type:Organization
Organization Name:ILLINOIS DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:312-814-5278
Mailing Address - Street 1:535 W JEFFERSON ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62761-0001
Mailing Address - Country:US
Mailing Address - Phone:217-782-4977
Mailing Address - Fax:217-782-3987
Practice Address - Street 1:825 N RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4910
Practice Address - Country:US
Practice Address - Phone:217-782-6562
Practice Address - Fax:217-524-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory