Basic Information
| Provider Information | |||||||||
| NPI: | 1497025977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESURRECTION SERVICES | ||||||||
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| OtherOrganizationName: | RMG MEDICAL CARDIOLOGY | ||||||||
| 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: | 2800 N SHERIDAN RD | ||||||||
| Address2: | STE 500 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606576156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733480700 | ||||||||
| FaxNumber: | 7733481235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2011 | ||||||||
| LastUpdateDate: | 12/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | MC CORMICK | ||||||||
| 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 | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.