Individual
DR. ETHAN LEWIS SEGAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2160 S 1ST AVE, MACGUIRE CENTER SUITE 2700, MAYWOOD, IL 60153-3328
(708) 216-8066
Mailing address
1024 DUNLOP AVE, APARTMENT B, FOREST PARK, IL 60130-3011
(617) 784-8982
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/13/2010
Last updated
05/13/2010
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