Provider Demographics
NPI:1063901189
Name:SEGREST, BRANDON WILLIAM (DO)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:WILLIAM
Last Name:SEGREST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:700 E OGDEN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1296
Mailing Address - Country:US
Mailing Address - Phone:630-528-3215
Mailing Address - Fax:630-528-3219
Practice Address - Street 1:700 E OGDEN AVE STE 202
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1296
Practice Address - Country:US
Practice Address - Phone:630-528-3215
Practice Address - Fax:630-528-3219
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036156993207R00000X, 208M00000X
MI1063901189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist