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General NPI Number Information
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NPI Number | 1780840488
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Entity Type | Individual
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Provider Name | MARK A. NESSIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 1 KISH HOSPITAL DR.
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City | DEKALB
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State | IL
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Zip | 60115-9602
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Country | US
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Telephone | 815-756-1521
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Fax | 815-748-8395
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Provider Business Mailing Address
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Address Line | 1 KISH HOSPITAL DR.
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City | DEKALB
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State | IL
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Zip | 60115-9602
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Country | US
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Telephone | 815-756-1521
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Fax | 815-748-8395
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 36.121278
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 336.082541
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License Number State | IL
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