Healthcare Provider Details

I. General information

NPI: 1396032462
Provider Name (Legal Business Name): RESURRECTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR SUITE 1208
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

PO BOX 564437
CHICAGO IL
60656-4437
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-4964
  • Fax:
Mailing address:
  • Phone: 708-583-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

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