Healthcare Provider Details

I. General information

NPI: 1942585211
Provider Name (Legal Business Name): RESURRECTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE #418
CHICAGO IL
60631-3745
US

IV. Provider business mailing address

PO BOX 564437
CHICAGO IL
60656-4437
US

V. Phone/Fax

Practice location:
  • Phone: 773-775-2180
  • Fax: 773-775-1987
Mailing address:
  • Phone: 708-583-7310
  • Fax: 708-583-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL MCCORMICK
Title or Position: SR VICE PRESIDENT
Credential:
Phone: 708-583-6817