Healthcare Provider Details

I. General information

NPI: 1215249412
Provider Name (Legal Business Name): RESURRECTION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE
CHICAGO IL
60631-3745
US

IV. Provider business mailing address

7447 W TALCOTT AVE
CHICAGO IL
60631-3745
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-5155
  • Fax: 773-594-7975
Mailing address:
  • Phone: 773-792-5155
  • Fax: 773-594-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number125057999
License Number StateIL

VIII. Authorized Official

Name: DR. WILLIAM MORAN
Title or Position: PROGRAM DIRECTOR
Credential: DO
Phone: 733-792-5155