Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Parent organization
DEPT OF SURGERY-CHS-WEISS
Other names
Dept of Surgery
Organization subpart
Yes
Provider details
NPI number
Legal business name
DEPT OF SURGERY-CHS-WEISS
Authorized official
DR. WILLIAM R. NICHOLAS PHD (EXECUTIVE DIRECTOR)
(312) 413-1350
Entity
Organization
Contact information
Practice address
840 S WOOD ST, MC 958, CHICAGO, IL 60612-4325
(312) 996-9336
Mailing address
135 S LASALLE ST DEPT 3449, CHICAGO, IL 60674-0001
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
204F00000X
Transplant Surgery Physician
—
—
208200000X
Plastic Surgery Physician
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0102X
Surgical Critical Care Physician
—
—
2086S0105X
Surgery of the Hand (Surgery) Physician
—
—
2086S0120X
Pediatric Surgery Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
2086S0127X
Trauma Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
IL
2086S0129X
Vascular Surgery Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004
TRICARE GROUP
IL
01
—
01618613
BCBS GROUP
IL
01
—
932760
MEDICARE GROUP
IL
01
—
CA8300
RAILROAD GROUP
IL
Enumeration date
06/22/2009
Last updated
06/22/2009
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