Healthcare Provider Details

I. General information

NPI: 1811153554
Provider Name (Legal Business Name): RESURRECTION MEDICAL CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE FAMILY PRACTICE CENTRE SUITE 182
CHICAGO IL
60631-3745
US

IV. Provider business mailing address

7447 W TALCOTT AVE FAMILY PRACTICE CENTRE SUITE 182
CHICAGO IL
60631-3745
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number025.055389
License Number StateIL

VIII. Authorized Official

Name: ROSANNE BROWNE
Title or Position: DR
Credential:
Phone: 312-480-5865