MEDICARE: OUR LADY OF THE RESURRECTION MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1306845763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR LADY OF THE RESURRECTION MEDICAL CENTER

Provider Business Mailing Address
First Line	:	520 E 22ND ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-6110
Country	:	US
Telephone Number	:	630-874-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	5645 W ADDISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4403
Country	:	US
Telephone Number	:	773-774-8000
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	MICHAEL S ROSENBERG
Credential	:	M.D.
Telephone Number	:	773-774-8000

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	11/26/2007

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