National Provider Identifier Database

KENNETH R NISSIM, MD – NPI #1447246392
Plastic Surgery within the Head & Neck

An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.


Contact Information

KENNETH R NISSIM, MD
1253 N ALPINE RD
ROCKFORD, IL61107-2201
Phone: 779-696-9201
Fax: 815-397-9667
Website:
Specialty Taxonomy Code
* Plastic Surgery within the Head & Neck 207YX0007X
Otolaryngology 207Y00000X
Sleep Medicine 207YS0012X

* Indicates primary specialty

NPI Profile & details for KENNETH R NISSIM

NPI Number 1447246392
Credentials MD
Entity Individual
Enumeration date 09/26/2005
Last updated 12/11/2024 - More than a year ago
Sole proprietor1 No
Identifiers
  • FL License #: ME85561
  • IL License #: 036170811
  • FL Medicaid: 2675617-00
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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