Provider Demographics
NPI:1497730220
Name:SEGAL, ALLEN M (DO)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:M
Last Name:SEGAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S GREEN RD STE 160
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-6100
Mailing Address - Country:US
Mailing Address - Phone:216-297-2084
Mailing Address - Fax:216-297-2910
Practice Address - Street 1:1611 S GREEN RD STE 160
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-6100
Practice Address - Country:US
Practice Address - Phone:216-297-2084
Practice Address - Fax:216-297-2910
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-002816207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0488762Medicaid
4549492OtherAETNA
OH0499603Medicare PIN
OHE66510Medicare UPIN