Provider Demographics
NPI:1164443073
Name:CORTEZ-LAPERA, MYRNA DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:DAVID
Last Name:CORTEZ-LAPERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16500 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-8233
Mailing Address - Country:US
Mailing Address - Phone:708-444-4366
Mailing Address - Fax:
Practice Address - Street 1:107 CLYDE AVE # 109
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-4001
Practice Address - Country:US
Practice Address - Phone:847-869-6315
Practice Address - Fax:847-869-7392
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics