Provider Demographics
NPI:1417162470
Name:SEGALL, THOMAS ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALLAN
Last Name:SEGALL
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 1:326 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2010
Mailing Address - Country:US
Mailing Address - Phone:734-994-5325
Mailing Address - Fax:734-662-1037
Practice Address - Street 1:326 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2010
Practice Address - Country:US
Practice Address - Phone:734-994-5325
Practice Address - Fax:734-662-1037
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010309782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB44818Medicare UPIN
MI0818842Medicare ID - Type Unspecified