Provider Demographics
NPI:1528406733
Name:SEGURA, LEILANI ALTAGRACIA (MD)
Entity type:Individual
Prefix:DR
First Name:LEILANI
Middle Name:ALTAGRACIA
Last Name:SEGURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E GRANT ST STE 111
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3315
Mailing Address - Country:US
Mailing Address - Phone:309-833-1729
Mailing Address - Fax:309-836-1779
Practice Address - Street 1:515 E GRANT ST STE 111
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3315
Practice Address - Country:US
Practice Address - Phone:309-833-1729
Practice Address - Fax:309-836-1779
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036171392208000000X
PAMT223934208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics