Healthcare Provider Details

I. General information

NPI: 1578643680
Provider Name (Legal Business Name): MARSHALL B SEGAL M,D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE RUSH COPLEY MEDICAL CENTER ED
AURORA IL
60504-7222
US

IV. Provider business mailing address

2142 N SEDGWICK ST
CHICAGO IL
60614-4620
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4810
  • Fax:
Mailing address:
  • Phone: 773-327-0777
  • Fax: 773-248-4825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: