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Organization
UNIVERSITY OF ILLINOIS
Active
Organization
UNIVERSITY OF ILLINOIS
Active
Other names
Medical Service Plan at Peoria
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM R NICHOLAS PHD (EXECUTIVE DIRECTOR OF MSP)
(312) 413-0573
Entity
Organization
Contact information
Practice address
ST JUDE MIDWEST AFFILIATE, 530 NE GLEN OAK, PEORIA, IL 61637-0001
(309) 624-4945
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 671-8503
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
—
NULL
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
—
—
Other
Enumeration date
02/01/2006
Last updated
08/22/2020
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