Provider Demographics
NPI:1558354449
Name:SEGAL, STEVEN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALAN
Last Name:SEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1810 BROAD RIPPLE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2357
Mailing Address - Country:US
Mailing Address - Phone:317-251-8550
Mailing Address - Fax:317-251-8611
Practice Address - Street 1:1810 BROAD RIPPLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2357
Practice Address - Country:US
Practice Address - Phone:317-251-8550
Practice Address - Fax:317-251-8611
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100277950Medicaid
IN080044688OtherMEDICARE RR PROVIDER NUMBER
IN100277950Medicaid
INC25994Medicare UPIN