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NPI Code Detail

MEDICARE: RESURRECTION SERVICES

MEDICARE: RESURRECTION SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1043327091
Entity Type Code : Organization
Provider Name (Legal Business Name) : RESURRECTION SERVICES
Provider Business Mailing Address
First Line : 7157 W HOWARD ST
Second Line :
City : NILES
State : IL
Zip : 60714-3757
Country : US
Telephone Number : 847-647-1771
Fax Number : 847-647-5981
Provider Business Practice Location Address
First Line : 7157 W HOWARD ST
Second Line :
City : NILES
State : IL
Zip : 60714-3757
Country : US
Telephone Number : 847-647-1771
Fax Number : 847-647-5981
Authorized Official
Title or Position : VICE PRESIDENT
Name : LEN DEDIC
Credential :
Telephone Number : 708-583-6818
Provider Enumeration Date : 08/24/2006
Last Update Date : 01/31/2008

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Directions to “RESURRECTION SERVICES ” Practice Location

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