Provider Demographics
NPI:1326248444
Name:SEGON, ANKUR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:
Last Name:SEGON
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 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:INTERNAL MEDICINE HOSPITALIST DIVISION
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-0820
Mailing Address - Fax:414-805-0988
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:INTERNAL MEDICINE HOSPITALIST DIVISION
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-0820
Practice Address - Fax:414-805-0988
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36118934207R00000X
WI51599207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI114973601Medicaid
WI114973601Medicaid