Healthcare Provider Details

I. General information

NPI: 1871514836
Provider Name (Legal Business Name): RESURRECTION MEDICAL CENTER - CHICAGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE
CHICAGO IL
60631-3760
US

IV. Provider business mailing address

7447 W TALCOTT AVE
CHICAGO IL
60631-3760
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-5030
  • Fax: 773-594-7841
Mailing address:
  • Phone: 773-792-5030
  • Fax: 773-594-7841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054.019888
License Number StateIL

VIII. Authorized Official

Name: CHRISTOPHER DOAN
Title or Position: MANAGING ASSOCIATE GENERAL COUNSEL
Credential:
Phone: 909-235-4307