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Organization
RESURRECTION SERVICES
Active
Organization
RESURRECTION SERVICES
Active
Other names
RMG LITTLE VILLAGE PRIMARY CARE
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL MC CORMICK (SR. VICE PRESIDENT)
(708) 583-6817
Entity
Organization
Contact information
Practice address
3814 W 26TH ST, CHICAGO, IL 60623-3807
(773) 522-5200
(773) 522-5356
Mailing address
PO BOX 564437, CHICAGO, IL 60656-4437
(708) 583-7310
(708) 583-9870
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
745367
MEDICARE PTAN
IL
Enumeration date
08/11/2011
Last updated
08/11/2011
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