Nissim, Kenneth Richard

Nissim, Kenneth Richard is an individual health care provider with primary practice located at 1253 N Alpine Rd , Rockford IL 61107-2201. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sleep Medicine, Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck, Allopathic & Osteopathic Physicians / Otolaryngology. Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck is his primary health care specialty. Nissim, Kenneth Richard can be contacted via phone (779) 696-9201.

Contact Information

Primary practice address
1253 N Alpine Rd Rockford IL 61107-2201
Phone: (779) 696-9201
Fax: (815) 397-9667
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sleep Medicine 207YS0012X ME85561 Florida
Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck 207YX0007X 036170811 Illinois
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X ME85561 Florida

Profile Details

NPI number 1447246392
LBN Legal business name Nissim, Kenneth Richard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2005
Last updated Dec 11th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1447246392 NPPES
Florida MEDICAID 2675617-00

Popular Providers