Organization
BOARD OF TRUSTEES FO THE UNIVERSITY OF ILLINOIS
Active
Other names
UIH-Mile Square Health Center at Cicero IHH
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY TAYLOR (CEO)
(312) 413-1261
Entity
Organization
Contact information
Practice address
4747-51 WEST CERMAK RD, CICERO, IL 60804-2508
(708) 656-4766
Mailing address
1220 S WOOD ST, CHICAGO, IL 60608-1202
(312) 413-1261
(312) 413-7812
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622185
BCBS PROVIDER
—
Enumeration date
10/23/2018
Last updated
11/27/2023
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