Provider Demographics
NPI:1992798078
Name:SEGAL, ROBERT M (MD)
Entity type:Individual
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First Name:ROBERT
Middle Name:M
Last Name:SEGAL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2910 CENTRE POINTE DR
Mailing Address - Street 2:35-121A CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1182
Mailing Address - Country:US
Mailing Address - Phone:651-855-2109
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:2325 CHICAGO AVE
Practice Address - Street 2:CHILDRENS PRIMARY CLINIC MPLS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3843
Practice Address - Country:US
Practice Address - Phone:612-813-6107
Practice Address - Fax:612-813-7473
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2012-08-30
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Provider Licenses
StateLicense IDTaxonomies
MN34077208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN091005800Medicaid
MN091005800Medicaid