MEDICARE: DR. JOSEPH D. RESES MD

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
1	207L00000X	Anesthesiology Physician	036-133205	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F400407539	OTHER	IL	MEDICARE

General Provider Information

NPI Number	:	1356526255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH D. RESES MD

Provider Business Mailing Address
First Line	:	5744 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-4302
Country	:	US
Telephone Number	:	312-335-0180
Fax Number	:	773-275-4679

Provider Business Practice Location Address
First Line	:	5744 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-4302
Country	:	US
Telephone Number	:	312-335-0180
Fax Number	:	773-275-4679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	06/01/2020

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