Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
Mile Square - IHC Thresholds North
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM R. NICHOLAS PHD (EXECUTIVE DIRECTOR MEDICAL PLAN UIC)
(312) 413-0573
Entity
Organization
Contact information
Practice address
4219 N LINCOLN AVE, IHC THRESHOLDS YOUNG ADULT PROGRAM, 3RD FLOOR, CHICAGO, IL 60618-2901
(312) 996-9354
(312) 996-7725
Mailing address
4219 N LINCOLN AVE, IHC THRESHOLDS YOUNG ADULT PROGRAM, 3RD FLOOR, CHICAGO, IL 60618-2901
(312) 996-9354
(312) 996-7725
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
09/20/2007
Last updated
07/22/2009
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