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Organization
UNIVERSITY OF ILLINOIS
Active
Organization
UNIVERSITY OF ILLINOIS
Active
Other names
Medical Service Plan @ Peoria
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM R NICHOLAS PHD (EX DIRECTOR OF MEDICAL SERVICE PLAN)
(312) 413-0573
Entity
Organization
Contact information
Practice address
530 NE GLEN OAK AVE, DEPT OF INTERNAL MEDICINE, PEORIA, IL 61637-0001
(309) 655-3292
(309) 655-7732
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 671-8503
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07215036
BCBS
IL
Enumeration date
01/25/2006
Last updated
08/22/2020
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