Healthcare Provider Details

I. General information

NPI: 1740778562
Provider Name (Legal Business Name): MATI SEGEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-7425
  • Fax:
Mailing address:
  • Phone: 513-584-7425
  • Fax: 513-584-7681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.144002
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: