Provider Demographics
NPI:1104027481
Name:CLIVE M. SEGIL, M.D., INC.
Entity Type:Organization
Organization Name:CLIVE M. SEGIL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEGIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-203-5490
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-203-5490
Mailing Address - Fax:310-203-5412
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-203-5490
Practice Address - Fax:310-203-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26735207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA83429Medicare UPIN