Healthcare Provider Details

I. General information

NPI: 1306845763
Provider Name (Legal Business Name): OUR LADY OF THE RESURRECTION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 W ADDISON ST
CHICAGO IL
60634-4403
US

IV. Provider business mailing address

520 E 22ND ST
LOMBARD IL
60148-6110
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-8000
  • Fax:
Mailing address:
  • Phone: 630-874-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S ROSENBERG
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 773-774-8000