Basic Information
| Provider Information | |||||||||
| NPI: | 1326318809 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RESURRECTION SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RMG SFH OB/GYN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 564437 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606564437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085837310 | ||||||||
| FaxNumber: | 7085839870 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 AUSTIN ST | ||||||||
| Address2: | SUITE 354 EAST TOWER | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602023439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474916890 | ||||||||
| FaxNumber: | 8474910274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2011 | ||||||||
| LastUpdateDate: | 12/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCCORMICK | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7085836817 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.