Healthcare Provider Details

I. General information

NPI: 1427385202
Provider Name (Legal Business Name): RESURRECTION AMBULATORY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 LAKE ST SUITE 2110
RIVER FOREST IL
60305-1876
US

IV. Provider business mailing address

15330 S LA GRANGE RD SUITE 203
ORLAND PARK IL
60462-3885
US

V. Phone/Fax

Practice location:
  • Phone: 708-763-2327
  • Fax: 708-488-2380
Mailing address:
  • Phone: 708-675-6180
  • Fax: 708-364-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN M. HOBSON
Title or Position: SYSTEM DIRECTOR
Credential:
Phone: 773-797-3603