Healthcare Provider Details

I. General information

NPI: 1326318809
Provider Name (Legal Business Name): RESURRECTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN ST SUITE 354 EAST TOWER
EVANSTON IL
60202-3439
US

IV. Provider business mailing address

PO BOX 564437
CHICAGO IL
60656-4437
US

V. Phone/Fax

Practice location:
  • Phone: 847-491-6890
  • Fax: 847-491-0274
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