Healthcare Provider Details

I. General information

NPI: 1487928198
Provider Name (Legal Business Name): RESURRECTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WINNETKA AVE SUITE B
WINNETKA IL
60093-4050
US

IV. Provider business mailing address

62311 COLLECTION CENTER DR
CHICAGO IL
60693-0623
US

V. Phone/Fax

Practice location:
  • Phone: 847-446-1112
  • Fax: 847-446-1717
Mailing address:
  • Phone: 800-273-2614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL MCCORMICK
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 708-583-6817