| NPI | 1922115864 |
|---|---|
| Former Legal Business Name | RESURRECTION SERVICES PRESENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | MELVONNE WICKLIFFE-JONES Credentialing Mgr 630-914-2417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209007288) |
| 207R00000X Internal Medicine (Licence: IL 036053397) | |
| 207R00000X Internal Medicine (Licence: IL 036054086) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2013-04-10 |