Healthcare Provider Details

I. General information

NPI: 1124135181
Provider Name (Legal Business Name): RESURRECTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10015 GRAND AVE
FRANKLIN PARK IL
60131-2546
US

IV. Provider business mailing address

10015 GRAND AVE
FRANKLIN PARK IL
60131-2546
US

V. Phone/Fax

Practice location:
  • Phone: 847-451-0643
  • Fax: 847-451-0792
Mailing address:
  • Phone: 847-451-0643
  • Fax: 847-451-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEN DEDIC
Title or Position: VICE PRESIDENT
Credential:
Phone: 708-583-6818