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Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
UIC Healthspan Faculty Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BO FERNHALL PH.D. (DEAN, APPLIED HEALTH SCIENCES)
(312) 996-6695
Entity
Organization
Contact information
Practice address
1640 W ROOSEVELT RD, ROOM 336, CHICAGO, IL 60608-1316
(312) 413-8043
Mailing address
5254 SOLUTION CENTER, CHICAGO, IL 60677-0001
(312) 996-4404
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
10/20/2016
Last updated
01/20/2022
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