Provider Demographics
NPI:1700131844
Name:SEGKOS, KONSTANTINOS (MD)
Entity Type:Individual
Prefix:
First Name:KONSTANTINOS
Middle Name:
Last Name:SEGKOS
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 1:2135 W MAIN ST STE B107
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6936
Mailing Address - Country:US
Mailing Address - Phone:801-655-6415
Mailing Address - Fax:
Practice Address - Street 1:2135 W MAIN ST STE B107
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6936
Practice Address - Country:US
Practice Address - Phone:801-655-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.025738207RE0101X
UT9876842-1205207RE0101X
MA252611207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine