Healthcare Provider Details

I. General information

NPI: 1992023501
Provider Name (Legal Business Name): REBECCA T LAPAT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 HARTREY AVE
EVANSTON IL
60202-1056
US

IV. Provider business mailing address

1701 W SUPERIOR ST
CHICAGO IL
60622-5646
US

V. Phone/Fax

Practice location:
  • Phone: 847-666-2325
  • Fax: 847-868-8964
Mailing address:
  • Phone: 847-666-3494
  • Fax: 847-868-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.132878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: