BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS (NPI# 1508085630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508085630 |
| Entity Type | Organization |
| Organization Name | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS |
| Other Organization Name | DEPT OF SURGICAL ONCOLOGY |
| Practice Address |
840 S Wood St Chicago IL 60612-7322 |
| Mailing Address |
135 S Lasalle St Dept 3454 Chicago IL 60674-3454 |
| Practice Telephone | 3129966666 |
| 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 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086X0206X |
Surgery Specialization: Surgical Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RAILROAD | CI2318 | 01 |
| IL | BCBS GROUP | 01618855 | 01 |
| Other Name | Type Code |
|---|---|
| Dept of Surgical Oncology | Other Name - Individual/Organization |
| 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 |
| 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 |
| Street Address |
840 S WOOD ST |
| City | CHICAGO |
| State | IL |
| Zip Code | 60612-7322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457354656 | Frederick G. Behm | Pathology | 840 S Wood St, Department of Pathology, Mc847, Chicago, IL 60612-4325 | 2005-05-23 |
| 1467065581 | Monica Joan Gingell | Nurse Practitioner | 840 S Wood St, Chicago, IL 60612-4325 | 2020-08-28 |
| 1003435926 | Kyle Corso Mork | Pharmacist | 840 S Wood St, Chicago, IL 60612-4325 | 2020-04-10 |
| 1841828282 | Hovig Chelebian | Student in an Organized Health Care Education/Training Program | 840 S Wood St, Chicago, IL 60612-4325 | 2020-03-31 |
| 1417585787 | Mehul Gilani | Student in an Organized Health Care Education/Training Program | 840 S Wood St, Chicago, IL 60612-4325 | 2020-03-31 |
| 1730736356 | Alice Zalan | Genetic Counselor, MS | 840 S Wood St, Chicago, IL 60612-4325 | 2019-08-19 |
| 1972155547 | Lenika De Simone | Genetic Counselor, MS | 840 S Wood St, Chicago, IL 60612-4325 | 2019-07-12 |
| 1528629961 | Melissa Duckett | Nurse Practitioner | 840 S Wood St, Chicago, IL 60612-4325 | 2019-06-26 |
| 1629631098 | Jonathan Alverio | Student in an Organized Health Care Education/Training Program | 840 S Wood St, Chicago, IL 60612-4325 | 2019-04-20 |
| 1225598766 | Daphne Porat | Student in an Organized Health Care Education/Training Program | 840 S Wood St, Chicago, IL 60612-4325 | 2019-03-21 |
| Find all providers in the same location | ||||
| 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 Code | 2086X0206X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Surgical Oncology |
| A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevention, diagnosis, treatment, and rehabilitation of cancer patients, and devotes a major portion of his or her professional practice to these activities and cancer research. |
| Notes: Source: Society of Surgical Oncology, 2007 [1/1/2008: definition added, source added, 7/1/2009: definiition reformatted] Additional Resources: http://www.surgonc.org/ ; American Board of Medical Specialties, 2007, www.abms.org ; American Board of Surgery, 2007, http://www.absurgery.org/ Surgical oncology is a recognized fellowship subspecialty program of surgery. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033162839 | Mark M. Connolly | Surgery | 2913 N Commonwealth Ave, 5th Floor, Chicago, IL 60657-6211 | 2006-05-19 |
| 1588662928 | Swati Kulkarni | Surgery | 250 E Superior St, Suite 420, Chicago, IL 60611-2914 | 2005-07-11 |
| 1235424656 | Fadi Suhail Dahdaleh | Surgery | 5841 S. Maryland Avenue, M/c 6040, Chicago, IL 60637 | 2011-06-14 |
| 1245556406 | Oliver S. Eng | Surgery | 5841 S Maryland Ave # Mc5094, Chicago, IL 60637-1443 | 2010-04-13 |
| 1699008706 | S. O. Group, S.c. | Surgery | 1725 W. Harrison Street, Suite 409, Chicago, IL 60612 | 2009-09-09 |
| 1942457072 | Anthony Yang | Surgery | 675 N Saint Clair St Ste 21-700, Chicago, IL 60611-5975 | 2008-08-20 |
| 1922265032 | Rohit Ramesh Sharma | Surgery | 5841 S Maryland Ave, Mc 6040, Chicago, IL 60637-1447 | 2008-05-18 |
| 1528114501 | Cdn Surgical Assoc., Ltd. | Surgery | 2913 N Commonwealth Ave, Chicago, IL 60657-6211 | 2007-01-25 |
| 1629171822 | Donald K Wood | Surgery | 1740 W Taylor St, Chicago, IL 60612-7232 | 2006-09-06 |
| 1275636482 | Tapas K. Dasgupta | Surgery | 1740 W Taylor St, Chicago, IL 60612-7232 | 2006-09-06 |
| Find all providers in CHICAGO | ||||
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| 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.