Provider Demographics
NPI:1225210230
Name:CHICAGO PERIPHERAL NERVE CENTER, LLC
Entity Type:Organization
Organization Name:CHICAGO PERIPHERAL NERVE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:P
Authorized Official - Last Name:SEGURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-335-3939
Mailing Address - Street 1:1221 N DEARBORN ST
Mailing Address - Street 2:N 1410
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:
Practice Address - Street 1:60 E DELWARE PLACE
Practice Address - Street 2:SUTIE 1480
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-355-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty