Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
UIH-Mile Square Health Center at Englewood
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY STECKER (CFO)
(312) 355-7653
Entity
Organization
Contact information
Practice address
641 W. 63RD ST, UIH-MILE SQUARE HEALTH CENTER AT ENGLEWOOD, CHICAGO, IL 60621-2032
(312) 413-4070
(312) 413-7812
Mailing address
1220 S. WOOD STREET, UIH-MILE SQUARE HEALTH CENTER, CHICAGO, IL 60608-1202
(312) 413-1261
(312) 413-7812
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622185
BCBS PROVIDER
IL
Enumeration date
07/27/2012
Last updated
06/27/2025
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