Organization
UNIVERSITY OF ILLINOIS
Active
Other names
Medical Service Plan
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM R NICHOLAS PHD (EXECUTIVE DIRECTOR MEDICAL SERVICE)
(312) 413-0573
Entity
Organization
Contact information
Practice address
320 E ARMSTRONG AVE, PEORIA, IL 61603-3172
(309) 624-9680
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 671-8503
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
01/20/2006
Last updated
08/22/2020
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