Provider Demographics
NPI:1538318308
Name:LERTSBURAPA, KEITH M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:M
Last Name:LERTSBURAPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SALT CREEK LN STE 101
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3032
Mailing Address - Country:US
Mailing Address - Phone:630-789-3110
Mailing Address - Fax:
Practice Address - Street 1:11 SALT CREEK LN STE 101
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3032
Practice Address - Country:US
Practice Address - Phone:630-789-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.127737207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology