Organization
RESURRECTION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL MCCORMICK FACHE (SENIOR VICE PRESIDENT)
(708) 583-6817
Entity
Organization
Contact information
Practice address
2900 N LAKE SHORE DR, SUITE 1208, CHICAGO, IL 60657-5640
(773) 665-4964
Mailing address
PO BOX 564437, CHICAGO, IL 60656-4437
(708) 583-7310
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036109067
—
IL
Enumeration date
07/08/2011
Last updated
07/08/2011
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