Basic Information
| Provider Information | |||||||||
| NPI: | 1669479317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORTLANDT | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3331 W DEYOUNG ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629595896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189987600 | ||||||||
| FaxNumber: | 6189986680 | ||||||||
| Practice Location | |||||||||
| Address1: | 609 W COURT ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WINNFIELD | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714832633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183023957 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036104607 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 64033111 | 05 | KY | MEDICAID | 200302200A | 05 | IN | MEDICAID |