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Organization
RESURRECTION SERVICES
Active
Organization
RESURRECTION SERVICES
Active
Other names
Viking Group
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL MCCORMICK FACHE (SENIOR VICE PRESIDENT)
(708) 583-6817
Entity
Organization
Contact information
Practice address
3500 W PETERSON AVE, SUITE 300, CHICAGO, IL 60659-3306
(773) 961-3200
(773) 867-6793
Mailing address
PO BOX 564437, CHICAGO, IL 60656-4437
(708) 583-7310
(708) 583-9870
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036101307
IL
207R00000X
Internal Medicine Physician
036047714
IL
207R00000X
Internal Medicine Physician
Primary
036079521
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036047714
—
IL
05
—
036079521
—
IL
05
—
036101307
—
IL
01
—
745367
MEDICARE PTAN
IL
Enumeration date
05/19/2011
Last updated
04/09/2012
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