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NPI Code Detail

MEDICARE: DR. GEORGE RONEN NISSAN DO

MEDICARE: DR. GEORGE RONEN NISSAN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianL0459TX
2207R00000XInternal Medicine Physician036108447IL

General Provider Information

NPI Number : 1245222033
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE RONEN NISSAN DO
Provider Business Mailing Address
First Line : 1460 N HALSTED ST STE 501
Second Line :
City : CHICAGO
State : IL
Zip : 60642-2615
Country : US
Telephone Number : 773-388-6390
Fax Number : 312-867-7101
Provider Business Practice Location Address
First Line : 1460 N HALSTED ST STE 501
Second Line :
City : CHICAGO
State : IL
Zip : 60642-2615
Country : US
Telephone Number : 773-388-6390
Fax Number : 312-867-7101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 08/08/2025

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Directions to “ DR. GEORGE RONEN NISSAN DO” Practice Location

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