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General NPI Number Information
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NPI Number | 1780693507
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Entity Type | Individual
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Provider Name | IAN (NMI) NISONSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6350 SW 87TH TER
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City | MIAMI
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State | FL
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Zip | 33143-8061
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Country | US
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Telephone | 305-667-3272
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Fax | 305-667-3272
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Provider Business Mailing Address
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Address Line | 6350 SW 87TH TER
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City | MIAMI
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State | FL
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Zip | 33143-8061
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Country | US
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Telephone | 305-667-3272
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Fax | 305-667-3272
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME15314
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License Number State | FL
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