Healthcare Provider Details

I. General information

NPI: 1972737963
Provider Name (Legal Business Name): RESURRECTION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 W TALCOTT AVE
CHICAGO IL
60631-3707
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: 630-874-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY J BALESTERI
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 773-774-8000