# THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** UIC Healthspan Faculty Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407307812
- **Authorized official:** DR. BO FERNHALL PH.D. (DEAN, APPLIED HEALTH SCIENCES)
- **Authorized official phone:** (312) 996-6695

## Contact information

- **Practice address:** 1640 W ROOSEVELT RD, ROOM 336, CHICAGO, IL 60608-1316
- **Practice address phone:** (312) 413-8043
- **Mailing address:** 5254 SOLUTION CENTER, CHICAGO, IL 60677-0001
- **Mailing address phone:** (312) 996-4404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/20/2016
- **Last updated:** 01/20/2022