Provider Demographics
NPI:1518979533
Name:SEGEL, NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:SEGEL
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 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-531-6686
Mailing Address - Fax:305-531-7027
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 520
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-531-6686
Practice Address - Fax:305-531-7027
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 17425207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD65617Medicare UPIN
FL91210ZMedicare PIN