Provider Demographics
NPI:1033283189
Name:SEGLIN, MELVIN N (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:N
Last Name:SEGLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 162
Mailing Address - Street 2:1510 W. OTTAWA RD.
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957
Mailing Address - Country:US
Mailing Address - Phone:217-379-4302
Mailing Address - Fax:217-379-4304
Practice Address - Street 1:1510 W. OTTAWA RD.
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957
Practice Address - Country:US
Practice Address - Phone:217-379-4302
Practice Address - Fax:217-379-4304
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360316112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL90203Medicaid
IL036031611Medicaid
IL036031611Medicaid
ILC40768Medicare UPIN