Healthcare Provider Details

I. General information

NPI: 1497730220
Provider Name (Legal Business Name): ALLEN M SEGAL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 S GREEN RD STE 160
SOUTH EUCLID OH
44121-6100
US

IV. Provider business mailing address

1611 S GREEN RD STE 160
SOUTH EUCLID OH
44121-6100
US

V. Phone/Fax

Practice location:
  • Phone: 216-297-2084
  • Fax: 216-297-2910
Mailing address:
  • Phone: 216-297-2084
  • Fax: 216-297-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number34-002816
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: