David E Nissan, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

036062588 Issued in IL

Practice address

5140 N California
Suite 550
Chicago, IL 60625

Phone

(773) 728-8800

Fax

(773) 728-0117

NPI assigned

Nov 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Daoud E Nissan Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dnissan276997@direct.northshore.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thorek Radiology Group NFP

  • Diagnostic Radiology Physician
  • Chicago, IL
  • NPI 1588261978
  NPD
• North America Rehab Services, Inc.

  dba Essence Physical Therapy

  • Physical Therapist
  • Chicago, IL
  • NPI 1952524563
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1215007877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA",
            "address_2": "SUITE 550",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60625",
            "telephone_number": "773-728-8800",
            "fax_number": "773-728-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA",
            "address_2": "SUITE 550",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60625",
            "telephone_number": "773-728-8800",
            "fax_number": "773-728-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSAN",
        "first_name": "DAVID",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036062588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036062588",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "31601661",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dnissan276997@direct.northshore.org",
            "affiliation": "N",
            "address_1": "5140 N California",
            "address_2": "Suite 550",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DAOUD",
            "last_name": "NISSAN",
            "middle_name": "E",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Nishii, MPH, BSN, RN
• Candy Nara Nishimura, P.T.
• Hokuto Nishioka, MD
• Liana Borisovna Nisimova, M.D.
• Sarah Nisivaco, MD
• George Ronen Nissan, DO
• Linora Nissan, DMD
• Michael Esha Nissan, MD
• Ninos Nissan, MD
• Nissi Dental Care Inc

• Otolaryngology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Otolaryngology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; 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.