Hani Peter Nissan

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

9229 Kenton Ave
Skokie, IL 60076-1526

Phone

(847) 414-4913

NPI assigned

Sep 10, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668902400000",
    "number": "1902155633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9229 KENTON AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761526",
            "telephone_number": "847-414-4913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9229 KENTON AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761526",
            "telephone_number": "847-414-4913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSAN",
        "first_name": "HANI",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-10",
        "last_updated": "2022-11-20",
        "certification_date": "2020-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "IL",
            "license": "238.000141",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Demetrios Nikoloulis, DPT
• Niles Township HS Di
• Niles TWP School Treasrer
• Nishaan Nagarakanti DO
• Nissa Foundation
• Stacey Nitka, LSW
• Nobel Medical Inc
• Linda Noia, APN-CRNA
• Sunena Ali Noorani
• Julie Noparstak, LCSW

• Surgical Physician Assistant in Skokie, IL
• Providers in Skokie, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2022; 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.