Michael a. Nissenbaum, MD, PA

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

MICHAEL A. NISSENBAUM, MD, PA

Practice address

194 E Main St
Fort Kent, ME 04743-1428

Phone

(207) 834-3155

NPI assigned

Aug 31, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael A Nissenbaum, MDNPI 1356328975

Title

President/ Owner

Phone

(207) 834-3155

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael A Nissenbaum, MD

  • Diagnostic Radiology Physician
  • Oklahoma City, OK
  • NPI 1356328975
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251676800000",
    "number": "1184857716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1849",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042411849",
            "telephone_number": "207-784-2554",
            "fax_number": "207-777-5363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 E MAIN ST",
            "city": "FORT KENT",
            "state": "ME",
            "postal_code": "047431428",
            "telephone_number": "207-834-3155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL A. NISSENBAUM, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-31",
        "last_updated": "2009-08-31",
        "status": "A",
        "authorized_official_last_name": "NISSENBAUM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/ OWNER",
        "authorized_official_telephone_number": "207-834-3155",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "186740000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lee Malmborg, RN-BSN
• Maritime Radiology Associates PC
• David Joshua Mayich, MD, FAAOS
• Paul H. McBreairty, MD
• Connie L. McLellan, R.D., L.D.
• Ellen Elizabeth Michalowski, MD
• Matthew Michaud, P.T.
• Monique Emma Michaud, RN
• Rebecca Michaud, RN-BSN
• Sara Kay Michaud, MS, LATC

• Diagnostic Radiology Physician in Fort Kent, ME
• Providers in Fort Kent, ME by specialty
• Diagnostic Radiology Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.