MEDICARE: DR. ASYA SEGALENE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KA0200X	Allergy Physician	036096611	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053391094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASYA SEGALENE M.D.

Provider Business Mailing Address
First Line	:	1020 E OGDEN AVE
Second Line	:	SUITE 205
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8609
Country	:	US
Telephone Number	:	630-852-4050
Fax Number	:	630-428-9764

Provider Business Practice Location Address
First Line	:	1020 E OGDEN AVE
Second Line	:	SUITE 205
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8609
Country	:	US
Telephone Number	:	630-852-4050
Fax Number	:	630-428-9764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	12/21/2011

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Directions to “ DR. ASYA SEGALENE M.D.” Practice Location

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