| Kenneth Richard Nissim, MD | |
|
1253 N Alpine Rd, Rockford, IL 61107-2201 | |
| (779) 696-9201 | |
| (815) 397-9667 |
| Full Name | Kenneth Richard Nissim |
|---|---|
| Gender | Male |
| Speciality | Otolaryngology - Plastic Surgery Within The Head & Neck |
| Location | 1253 N Alpine Rd, Rockford, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447246392 | NPI | - | NPPES |
| 2675617-00 | Medicaid | FL |
| Entity Name | Lakeland Regional Health Systems Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1497748743 PECOS PAC ID: 8325952914 Enrollment ID: O20031118000384 |
| Entity Name | University of Miami |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013967827 PECOS PAC ID: 3274795109 Enrollment ID: O20200406001006 |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth Richard Nissim, MD 1120 Nw 14th St, 5th Floor, Miami, FL 33136-2107 Ph: (305) 243-3564 | Kenneth Richard Nissim, MD 1253 N Alpine Rd, Rockford, IL 61107-2201 Ph: (779) 696-9201 |
Dr. Terrence R Loughlin, MD Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 698 Featherstone Rd, Rockford, IL 61107 Phone: 815-398-3277 |
Adam Soliman, MD Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 3401 N Perryville Rd, Rockford, IL 61114 Phone: 815-971-2000 |
Dr. Ronald V. Washak, D.O. Otolaryngology Medicare: Not Enrolled in Medicare Practice Location: 2300 N Rockton Ave, Plastic Surgery Dept, Rockford, IL 61103 Phone: 815-971-2000 Fax: 815-971-9924 |
Dr. Kurren Gill, M.D. Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 8201 E Riverside Blvd, Rockford, IL 61114 Phone: 815-971-7000 |
Sanjay Prasad, M.D. Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 1253 N Alpine Rd, Rockford, IL 61107 Phone: 779-696-9201 Fax: 815-397-9667 |
Mark L. Lundine, Otolaryngology Medicare: Not Enrolled in Medicare Practice Location: 1253 N Alpine Rd, Rockford, IL 61107 Phone: 779-696-9201 |
Margaret Provenza, Otolaryngology Medicare: Not Enrolled in Medicare Practice Location: 1253 N Alpine Rd, Rockford, IL 61107 Phone: 779-696-9201 |