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Organization
UNIVERSAL HEALTH, LTD
Active
Organization
UNIVERSAL HEALTH, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLGA MAVASHEV (OFFICE MANAGER)
(773) 271-1500
Entity
Organization
Contact information
Practice address
1007 W LAWRENCE AVE, CHICAGO, IL 60640-5017
(773) 271-1500
(773) 271-2048
Mailing address
994 COVENTRY LN, HIGHLAND PARK, IL 60035-3748
(773) 271-1500
(773) 271-2048
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036101294
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01626490
BCBS
IL
01
—
036101294
LISENCE
IL
05
—
036101294
—
IL
Enumeration date
11/09/2007
Last updated
10/13/2020
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