Provider Demographics
NPI:1457052342
Name:SEGERSTEN, SHAMUS DEAN
Entity Type:Individual
Prefix:
First Name:SHAMUS
Middle Name:DEAN
Last Name:SEGERSTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PARKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DAHINDA
Mailing Address - State:IL
Mailing Address - Zip Code:61428-9516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 PARKWOOD CIR
Practice Address - Street 2:
Practice Address - City:DAHINDA
Practice Address - State:IL
Practice Address - Zip Code:61428-9516
Practice Address - Country:US
Practice Address - Phone:224-828-4695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program