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General NPI Number Information
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NPI Number | 1225210230
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Entity Type | Organization
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Legal Business Name | CHICAGO PERIPHERAL NERVE CENTER, LLC
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 60 E DELWARE PLACE SUTIE 1480
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-355-3939
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 N DEARBORN ST N 1410
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City | CHICAGO
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State | IL
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Zip | 60610-2256
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Country | US
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Telephone | 312-335-3939
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROBERTO P SEGURA
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Credential | MD
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Telephone | 312-335-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State | IL
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