MEDICARE: DR. DOUGLAS JACK SEGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	4301041278	MI

General Provider Information

NPI Number	:	1447297759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS JACK SEGAN MD

Provider Business Mailing Address
First Line	:	PO BOX 1010
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48826-1010
Country	:	US
Telephone Number	:	517-337-8028
Fax Number	:

Provider Business Practice Location Address
First Line	:	6165 INNKEEPERS CT
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-1641
Country	:	US
Telephone Number	:	517-337-8028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/08/2007

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