Provider Demographics
NPI:1215044722
Name:SEGURA, ROBERTO P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:P
Last Name:SEGURA
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 1:1221 N DEARBORN ST
Mailing Address - Street 2:SUITE 1410 N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2256
Mailing Address - Country:US
Mailing Address - Phone:312-335-3939
Mailing Address - Fax:312-335-5469
Practice Address - Street 1:2913 N COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6211
Practice Address - Country:US
Practice Address - Phone:312-335-3939
Practice Address - Fax:312-335-5469
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360561052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635533OtherBCBS
D14192Medicare UPIN
213093Medicare ID - Type Unspecified