Healthcare Provider Details

I. General information

NPI: 1295742906
Provider Name (Legal Business Name): NAVA ANDRA SEGALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 N LINCOLN AVE
CHICAGO IL
60618-3028
US

IV. Provider business mailing address

PO BOX 10465
CHICAGO IL
60610-0465
US

V. Phone/Fax

Practice location:
  • Phone: 773-883-2350
  • Fax: 773-883-2351
Mailing address:
  • Phone: 773-883-2350
  • Fax: 773-883-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036099451
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: