Healthcare Provider Details

I. General information

NPI: 1801888441
Provider Name (Legal Business Name): MARK SEHGAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E VAN BUREN AVE
MCALESTER OK
74502
US

IV. Provider business mailing address

1401 E VAN BUREN AVE PO BOX 908
MCALESTER OK
74501-4245
US

V. Phone/Fax

Practice location:
  • Phone: 918-421-8446
  • Fax: 918-423-4051
Mailing address:
  • Phone: 918-421-8446
  • Fax: 918-423-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number24851
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: