Provider Demographics
NPI:1669473666
Name:SEGALOFF, DAVID SIMON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SIMON
Last Name:SEGALOFF
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 1:15990 WEST NINE MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4826
Mailing Address - Country:US
Mailing Address - Phone:248-849-4226
Mailing Address - Fax:248-849-4240
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-465-4847
Practice Address - Fax:248-465-4477
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301054871208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI291647510Medicaid
MI291647510Medicaid
MI0F36485008Medicare ID - Type Unspecified