MEDICARE: RESURRECTION MEDICAL CENTER - CHICAGO LLC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	054.019888	IL

General Provider Information

NPI Number	:	1871514836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURRECTION MEDICAL CENTER - CHICAGO LLC

Provider Business Mailing Address
First Line	:	7447 W TALCOTT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3760
Country	:	US
Telephone Number	:	773-792-5030
Fax Number	:	773-594-7841

Provider Business Practice Location Address
First Line	:	7447 W TALCOTT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3760
Country	:	US
Telephone Number	:	773-792-5030
Fax Number	:	773-594-7841

Authorized Official
Title or Position	:	MANAGING ASSOCIATE GENERAL COUNSEL
Name	:	CHRISTOPHER DOAN
Credential	:
Telephone Number	:	909-235-4307

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	04/16/2025

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