Healthcare Provider Details

I. General information

NPI: 1700131844
Provider Name (Legal Business Name): KONSTANTINOS SEGKOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 W MAIN ST STE B107
LEHI UT
84043-6936
US

IV. Provider business mailing address

2135 W MAIN ST STE B107
LEHI UT
84043-6936
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-6415
  • Fax:
Mailing address:
  • Phone: 801-655-6415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number252611
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number57.025738
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number9876842-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: