Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
University of Illinois Medical Service Plan at Peoria, Medical Service Plan at Peoria
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY LEONARD (DIRECTOR OF FISCAL AFFAIRS)
(309) 680-8649
Entity
Organization
Contact information
Practice address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 680-8649
(309) 671-8513
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 671-8472
(309) 671-8513
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RI0200X
Infectious Disease Physician
—
IL
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07215036
BCBS
IL
01
—
CH0107
RAILROAD MEDICARE
IL
Enumeration date
02/10/2006
Last updated
08/06/2024
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