Healthcare Provider Details

I. General information

NPI: 1245674837
Provider Name (Legal Business Name): JEFFREY RICHARD SEGNITZ B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 SUMMIT DR
WATERFORD MI
48328-3364
US

IV. Provider business mailing address

279 SUMMIT DR
WATERFORD MI
48328-3364
US

V. Phone/Fax

Practice location:
  • Phone: 248-409-4163
  • Fax: 248-745-6872
Mailing address:
  • Phone: 248-409-4163
  • Fax: 248-745-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: