Provider Demographics
NPI:1285837104
Name:SEGAL, NOLAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:M
Last Name:SEGAL
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 1:6465 WAYZATA BOULEVARD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1734
Mailing Address - Country:US
Mailing Address - Phone:952-236-7266
Mailing Address - Fax:952-236-7212
Practice Address - Street 1:6465 WAYZATA BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1728
Practice Address - Country:US
Practice Address - Phone:952-236-7266
Practice Address - Fax:952-236-7212
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN271210500Medicaid
MN03388DAOtherBLUE CROSS BLUE SHIELD MN
MN0929927OtherMEDICA
MNC808OtherUCARE
MN271210500Medicaid
MN0929927OtherMEDICA