1417907700 NPI number — MORRIS ESFORMES & MELVIN SEGAL ETAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417907700 NPI number — MORRIS ESFORMES & MELVIN SEGAL ETAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRIS ESFORMES & MELVIN SEGAL ETAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417907700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6865 N LINCOLN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLNWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60712-4611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-674-5795
Provider Business Mailing Address Fax Number:
847-674-5794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2230 MCDONOUGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60436-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-729-3801
Provider Business Practice Location Address Fax Number:
815-730-0960
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINFELD
Authorized Official First Name:
AVRUM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
847-674-5795

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  0022905 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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