Kenneth Richard Nissim, M.D.
Otolaryngology, Plastic Surgery within the Head & Neck in Rockford, IL. Individual provider (NPI-1).
NPI number1447246392
StatusActive
Last updated in NPPESDec 11, 2024
Details
- NPI
- 1447246392
- Entity type
- Individual (NPI-1)
- Name
- Kenneth Richard Nissim
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 26, 2005
- Certification date
- Dec 11, 2024
- Last updated
- Dec 11, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207YX0007X | Otolaryngology, Plastic Surgery within the Head & Neck | 036170811 | IL | Yes |
| 207YS0012X | Otolaryngology, Sleep Medicine | ME85561 | FL | |
| 207Y00000X | Otolaryngology | ME85561 | FL |
Practice location
1253 N Alpine RdRockford, IL 61107-2201
Phone 779-696-9201 · Fax 815-397-9667
Mailing address
1120 Nw 14th St5th Floor
Miami, FL 33136-2107
Phone 305-243-3564 · Fax 305-243-2009
Other practice locations
8932 Sw 97th Ave
Miami, FL 33176-1936
Miami, FL 33176-1936
Phone 305-270-3740
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