Healthcare Provider Details

I. General information

NPI: 1659650414
Provider Name (Legal Business Name): RESURRECTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 W 26TH ST
CHICAGO IL
60623-3807
US

IV. Provider business mailing address

PO BOX 564437
CHICAGO IL
60656-4437
US

V. Phone/Fax

Practice location:
  • Phone: 773-522-5200
  • Fax: 773-522-5356
Mailing address:
  • Phone: 708-583-7310
  • Fax: 708-583-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL MC CORMICK
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 708-583-6817