MEDICARE: ROBERT P. NISENBAUM M.D.

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
1	207R00000X	Internal Medicine Physician	A65903	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295732154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT P. NISENBAUM M.D.

Provider Business Mailing Address
First Line	:	3533 COY DR
Second Line	:	SUITE 1609
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-4542
Country	:	US
Telephone Number	:	310-308-0640
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E
Second Line	:	SUITE 1609
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2001
Country	:	US
Telephone Number	:	310-553-7151
Fax Number	:	310-286-2184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	04/21/2016

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