1598971517 NPI number — STEWART B. SEGAL, MD, SC,

Table of content: (NPI 1598971517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598971517 NPI number — STEWART B. SEGAL, MD, SC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEWART B. SEGAL, MD, SC,
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:
LAKE ZURICH FAMILY TREATMENT CENTER
Provider Other Organization Name Type Code:
3
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:
1598971517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 S RAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ZURICH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60047-2357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-540-8020
Provider Business Mailing Address Fax Number:
847-540-8125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 S RAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ZURICH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60047-2357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-540-8020
Provider Business Practice Location Address Fax Number:
847-540-8125
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEGAL
Authorized Official First Name:
STEWART
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
847-540-8020

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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)

  • Identifier: 1134121965 . This is a "MAKIKO OGINO, PA-C, NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1366444184 . This is a "JACK C. ENTER, PA-C, NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1881696789 . This is a "STEWART B. SEGAL, MD NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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