Provider Demographics
NPI:1598971517
Name:STEWART B. SEGAL, MD, SC,
Entity Type:Organization
Organization Name:STEWART B. SEGAL, MD, SC,
Other - Org Name:LAKE ZURICH FAMILY TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:B
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-540-8020
Mailing Address - Street 1:504 S RAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2357
Mailing Address - Country:US
Mailing Address - Phone:847-540-8020
Mailing Address - Fax:847-540-8125
Practice Address - Street 1:504 S RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2357
Practice Address - Country:US
Practice Address - Phone:847-540-8020
Practice Address - Fax:847-540-8125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1134121965OtherMAKIKO OGINO, PA-C, NPI
IL1366444184OtherJACK C. ENTER, PA-C, NPI
IL1881696789OtherSTEWART B. SEGAL, MD NPI
IL1881696789OtherSTEWART B. SEGAL, MD NPI
ILS89862Medicare UPIN
IL1134121965OtherMAKIKO OGINO, PA-C, NPI
ILP80482Medicare UPIN
IL204674Medicare ID - Type UnspecifiedMAKIKO OGINO, PA-C
ILL11557Medicare ID - Type UnspecifiedSTEWART B. SEGAL, MD