NPI 1003218348

Board of Trustees of the University of Illinois

Organisation Family Medicine Physician Rockford, IL

Practice location

Address: 1601 Parkview Ave, Rockford, IL 61107-1822
Phone: (815) 395-5637
Fax: (815) 395-5887

Authorised official

Name: Uma Sriram
Title: Director of Fiscal Affairs
Phone: (815) 395-5637

Registered specialties (3)

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X

Other Family Medicine providers in Illinois →

Clinical Social Worker

Behavioral Health & Social Service Providers Taxonomy 1041C0700X

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Marriage & Family Therapist

Behavioral Health & Social Service Providers Taxonomy 106H00000X

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Registry record

NPI: 1003218348
Entity type: Organization
NPI issued: 18 Sep 2014
Record last updated: 27 Apr 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.