Provider Demographics
NPI:1528233087
Name:NAVA SEGALL MD SC
Entity Type:Organization
Organization Name:NAVA SEGALL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-883-2350
Mailing Address - Street 1:PO BOX 10465
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-0465
Mailing Address - Country:US
Mailing Address - Phone:773-883-2350
Mailing Address - Fax:773-883-2351
Practice Address - Street 1:4116 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3028
Practice Address - Country:US
Practice Address - Phone:773-883-2350
Practice Address - Fax:773-883-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360994512080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099451OtherBLUE CROSS AND BLUE SHIELD
IL0360999451Medicaid