BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS (NPI# 1760601892) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760601892 |
| Entity Type | Organization |
| Organization Name | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS |
| Other Organization Name | DEPT OF UROLOGY |
| Practice Address |
820 S Wood St Chicago IL 60612-4325 |
| Mailing Address |
135 S Lasalle St Dept 3451 Chicago IL 60674-3451 |
| Practice Telephone | 3129962779 |
| 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 |
|---|---|---|---|---|---|
| X | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| X | 2088P0231X |
Urology Specialization: Pediatric Urology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RAILROAD GROUP | CG6661 | 01 |
| IL | BCBS GROUP | 01619048 | 01 |
| Other Name | Type Code |
|---|---|
| Dept of Urology | 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 |
820 S WOOD ST |
| City | CHICAGO |
| State | IL |
| Zip Code | 60612-4325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194727909 | Mark Allen Grevious | Plastic Surgery | 820 S Wood St, Suite 515 Csn (mc 958), Chicago, IL 60612-4325 | 2005-08-11 |
| 1093336968 | Sofia Sami | Student in an Organized Health Care Education/Training Program | 820 S Wood St, Chicago, IL 60612-4325 | 2020-05-02 |
| 1629592639 | Mahmoud Mima | Urology | 820 S Wood St, Csn 515, Chicago, IL 60612 | 2017-08-01 |
| 1023541398 | Kumar Siddharth Lal | Student in an Organized Health Care Education/Training Program | 820 S Wood St, Suite 100 Csn, M/c 675, Chicago, IL 60612-4325 | 2017-04-04 |
| 1437681970 | Jerome Martin | Emergency Medicine | 820 S Wood St, Chicago, IL 60612-4325 | 2017-04-03 |
| 1013370691 | Adam Kosloff | Student in an Organized Health Care Education/Training Program | 820 S Wood St, Mc 675, Chicago, IL 60612-4325 | 2016-04-01 |
| 1295198166 | Sanmeet Singh | Student in an Organized Health Care Education/Training Program | 820 S Wood St, Chicago, IL 60612-4325 | 2016-03-30 |
| 1417310244 | Yahia Zaki Almallah | Urology | 820 S Wood St, Csn Suit 515 M/c 955, Chicago, IL 60612-4325 | 2016-03-30 |
| 1962891606 | Alexandra Albanese | Family Medicine | 820 S Wood St, Suite 100 Csn, Chicago, IL 60612-4325 | 2015-01-19 |
| 1114332012 | Board of Trustees of The University of Illinois | Health Maintenance Organization | 820 S Wood St, Suite W310 - M/c 974, Chicago, IL 60612-4325 | 2014-06-30 |
| 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 | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699236612 | Behdod Katebian | Urology | 5841 S Maryland Ave Rm J-653, Chicago, IL 60637-1443 | 2019-03-31 |
| 1134657026 | Soojin Kim | Urology | 225 E. Chicago Avenue, Box 24, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611 | 2017-05-23 |
| 1790164002 | Shay Golan | Urology | 5841 S Maryland Ave Mc6038, Chicago, IL 60637-1447 | 2015-05-20 |
| 1528453594 | Christopher Stockdale | Urology | 300 W Hill St Apt 707, Chicago, IL 60610-7537 | 2015-04-06 |
| 1639568447 | Jeremy Lai | Urology | 420 E Superior St Ste 9-900, Chicago, IL 60611-4494 | 2015-01-16 |
| 1174933048 | Kyle John Ericson | Urology | 924 E 57th St, Suite 104, Chicago, IL 60637-1455 | 2014-05-01 |
| 1467878314 | Oluwarotimi Sewedo Nettey | Urology | 1524 S. Sangamon Street, Unit 403, Chicago, IL 60608 | 2014-03-14 |
| 1881957405 | Ricardo R Rios | Urology | 5600 W Addison St Ste 305, Chicago, IL 60634-4468 | 2012-06-19 |
| 1972863124 | James Wren | Urology | 675 N Saint Clair St Fl 20, Chicago, IL 60611 | 2012-05-22 |
| 1780940023 | Ryan Patrick Werntz | Urology | 5841 S Maryland Ave # 6038, Chicago, IL 60637-1447 | 2012-04-11 |
| 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.