# UNIVERSITY OF ILLINOIS AT CHICAGO MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639306228
- **Authorized official:** DR. USHA RAJ M.D. (PROFESSOR/ HEAD DEPT OF PEDIATRICS)
- **Authorized official phone:** (312) 413-1429

## Contact information

- **Practice address:** 840 S WOOD ST, CHICAGO, IL 60612-4325
- **Practice address phone:** (312) 413-1429
- **Mailing address:** 1105 BRIGHTON DR, CAROL STREAM, IL 60188-4327
- **Mailing address phone:** (630) 483-1789

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 209007222 | IL | Yes |
| 273100000X | Epilepsy Hospital Unit | 209007222 | IL | — |

## Other

- **Enumeration date:** 06/22/2009
- **Last updated:** 06/22/2009