Provider Demographics
NPI:1184990319
Name:SEGAL, SHELDON JAY (MD)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:JAY
Last Name:SEGAL
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 1:9901 OAK RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-4648
Mailing Address - Country:US
Mailing Address - Phone:952-933-3737
Mailing Address - Fax:
Practice Address - Street 1:9901 OAK RIDGE TRL
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-4648
Practice Address - Country:US
Practice Address - Phone:952-933-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15372208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery