Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
UIC MERIT
Organization subpart
No
Provider details
NPI number
Authorized official
LOREEN SUE DIDIER (CREDENTIALING SPECIALIST)
(815) 395-5861
Entity
Organization
Contact information
Practice address
2350 N ROCKTON AVE STE 204, ROCKFORD, IL 61103-3669
(815) 395-8812
Mailing address
1601 PARKVIEW AVE, ROCKFORD, IL 61107-1822
(815) 395-5861
(815) 395-5575
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
06/03/2006
Last updated
08/18/2022
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