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Individual
KENNETH RICHARD NISSIM
Active
Individual
KENNETH RICHARD NISSIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
ME85561
FL
207YS0012X
Sleep Medicine (Otolaryngology) Physician
ME85561
FL
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
036170811
IL
Other
Enumeration date
09/26/2005
Last updated
12/11/2024
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