Individual
DAVID E NISSAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5140 N CALIFORNIA, SUITE 550, CHICAGO, IL 60625
(773) 728-8800
(773) 728-0117
Mailing address
5140 N CALIFORNIA, SUITE 550, CHICAGO, IL 60625
(773) 728-8800
(773) 728-0117
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036062588
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062588
—
IL
01
—
31601661
BCBS
IL
Enumeration date
11/09/2006
Last updated
04/12/2021
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