BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS


Address: 808 S Wood St, Chicago, IL 60612-7300
Phone: 3129966966

BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS (NPI# 1265651434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1265651434
Entity Type Organization
Organization Name BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Other Organization Name UIC DEPT OF DERMATOLOGY
Practice Address 808 S Wood St
Chicago
IL 60612-7300
Mailing Address 135 S La Salle St
Dept 3450
Chicago
IL 60674-3450
Practice Telephone 3129966966
Enumeration Date 2007-04-25
Last Update Date 2020-08-22
Authorized Official Name DR. WILLIAM R NICHOLAS (EXECUTIVE DIRECTOR)
Authorized Official Telephone 3124131350
Authorized Official Credential PH.D.
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207N00000X Dermatology Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IL RAILROAD GROUP CG9096 01
IL BCBS GROUP 01618685 01

Other Provider/Organization Names

Other Name Type Code
UIC Dept of Dermatology Other Name - Individual/Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1720555147 Board of Trustees of The University of Illinois Case Management 3014 W 39th Pl, Chicago, IL 60632-2402 2018-10-24
1447390125 Board of Trustees of The University of Illinois Pharmacy 722 W Maxwell St, Room 205 Mc 184, Chicago, IL 60607-5002 2007-02-08
1790704484 Board of Trustees of The University of Illinois Clinic/Center 1059 W 13th St, Chicago, IL 60608-1526 2006-07-19
1467425322 Board of Trustees of The University of Illinois Internal Medicine Medical Service Plan, One Illini Dr, Peoria, IL 61656 2006-02-10
1790252047 Board of Trustees of The University of Illinois Case Management 55 W Cermak Rd, Chicago, IL 60616-2001 2018-10-25
1295202554 Board of Trustees of The University of Illinois Case Management 1628 W Washington Blvd, Chicago, IL 60612-2613 2018-10-25
1972070225 Board of Trustees of The University of Illinois Case Management 2641 S Calumet Ave, Chicago, IL 60616-2901 2018-10-25
1720554264 Board of Trustees of The University of Illinois Case Management 1220 S Wood St, Chicago, IL 60608-1202 2018-10-23
1770059156 Board of Trustees of The University of Illinois Case Management 8131 S May St, Chicago, IL 60620-3007 2018-10-23
1558837922 Board of Trustees of The University of Illinois Case Management 641 W 63rd St, Chicago, IL 60621-2032 2018-10-23

Other Data Sources

Entity Type Entity Name Entity Address
System for Award Management (SAM) Entities BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS 809 S Marshfield Ave Rm214, Chicago, IL 60612-4305
System for Award Management (SAM) Entities BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS, THE 364 Henry Administration Bldg, Urbana, IL 61801

Office Location

Street Address 808 S WOOD ST
City CHICAGO
State IL
Zip Code 60612-7300

Providers in the same location

NPI Name Taxonomy Address Enumeration
1598767410 Trevonne M. Thompson Emergency Medicine 808 S Wood St, Mc724, Chicago, IL 60612-7300 2005-08-11
1063047009 Sherin Mahrat Student in an Organized Health Care Education/Training Program 808 S Wood St, Chicago, IL 60612-7300 2020-03-10
1154828879 Francis Villanueva Emergency Medicine 808 S Wood St, Chicago, IL 60612-7300 2018-04-09
1134624505 Taryn Murray Student in an Organized Health Care Education/Training Program 808 S Wood St, Chicago, IL 60612-7300 2018-03-28
1336503226 Patrick Owen Mccaffrey Emergency Medicine 808 S Wood St, M/c 724, Chicago, IL 60612-7300 2016-04-07
1710366968 Sal Manuel Sebastian Calo Internal Medicine 808 S Wood St, 469 Cme, M/c 724, Chicago, IL 60612-7300 2015-05-20
1649615733 Annie-laurie Auden Student in an Organized Health Care Education/Training Program 808 S Wood St, 469 Cme, M/c 724, Chicago, IL 60612-7300 2013-05-03
1548587504 Katherine Bayer Emergency Medicine 808 S Wood St, 469 Cme, M/c 724, Chicago, IL 60612-7300 2010-04-29
1114153475 David Charles Snow Emergency Medicine 808 S Wood St, Room 471, Chicago, IL 60612-7300 2009-06-01
1144476516 Seema Awatramani Emergency Medicine 808 S Wood St, Chicago, IL 60612-7300 2008-08-17
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1144839739 Sandhya Shri Kannayiram Internal Medicine 1901w Harrison Street, Chicago, IL 60612 2020-07-29
1568080174 Nastaran Ordoyo Haghani Rad Student in an Organized Health Care Education/Training Program 1950 W. Polk Street, Room 6203, Chicago, IL 60612 2020-07-09
1669090403 Marianne Gagnon-konamna Student in an Organized Health Care Education/Training Program 1950 West Polk Street, Chicago, IL 60612 2020-07-08
1922625672 Tanya Montgomery Nee Brown Pediatrics 1950 West Polk Street, Neonatal and Perinatal Department, Chicago, IL 60612 2020-06-29
1124643028 Ashley Swan Dentist 801 S. Paulina St, Uic College of Dentistry - Endodontics Clinic, Chicago, IL 60612 2020-06-16
1831711381 Baillie Anne Bronner Obstetrics & Gynecology 1653 W Congress Pkwy Chicago, Il 60612, Chicago, IL 60612 2020-05-07
1154942449 Keisha Davell Cole Case Manager/Care Coordinator 612 S Western Ave Unit 1, Chicago, IL 60612 2020-04-28
1275153777 Isac Lim Student in an Organized Health Care Education/Training Program 1234 S. Wells, Chicago, IL 60612 2020-04-24
1578183414 Zachary Belden Student in an Organized Health Care Education/Training Program Uic Psychiatry Residency 912 S. Wood St., Rm 130b Npi-s (mc 913), Chicago, IL 60612 2020-04-21
1548880560 Christina Nunez Student in an Organized Health Care Education/Training Program 801 S. Paulina Street, M/c 850, Chicago, IL 60612 2020-04-20
Find all providers in zip 60612

Taxonomy Information

Taxonomy Code 207N00000X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology

Taxonomy Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1114551983 Katherine Janezic Dermatology 7447 W Talcott Ave Ste 425, Chicago, IL 60631-3704 2020-03-02
1487116240 Conrad Petersen Dermatology Sc Dermatology 2845 N Sheridan, Chicago, IL 60657 2019-04-02
1891257853 Maria Estela Martinez Escala Dermatology 5841 S Maryland Ave Ste Mc5067, Chicago, IL 60637-1443 2019-04-01
1275013450 Advanced Dermatology and Aesthetic Medicine Dermatology 850 S Wabash Ave Ste 200, Chicago, IL 60605-3642 2018-08-17
1346784543 Dermio, LLC Dermatology 3023 N Clark St, Suite 861, Chicago, IL 60657-5200 2016-12-07
1366823544 Oyinade Aderibigbe Dermatology 111 W Washington St Ste 1801, Chicago, IL 60602-3430 2015-06-14
1073909032 Julia Dai Dermatology 5758 S Maryland Ave Fl 3, Chicago, IL 60637 2015-04-07
1437544582 Nicholas Blickenstaff Dermatology 30 N Michigan Ave Ste 1429, Chicago, IL 60602-3698 2015-04-04
1801285929 Medical Dermatology Associates of Chicago, Ltd Dermatology 363 W Erie St, Suite 350, Chicago, IL 60654-6903 2015-01-13
1366857286 Noor Tazudeen Dermatology 4700 N Marine Dr Ste 220, Chicago, IL 60640-7972 2014-06-30
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Competitor

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City CHICAGO
Zip Code 60612

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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