ELIOT M NISSENBAUM (NPI# 1326082454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326082454 |
| Entity Type | Individual |
| Full Name | ELIOT M NISSENBAUM |
| Credential | DO |
| Practice Address |
1102 N County Road 700 Warsaw IL 62379-3011 |
| Mailing Address |
927 Broadway St Quincy IL 62301-2719 |
| Practice Telephone | 2172564100 |
| Practice Fax Number | 2172563800 |
| Mailing Telephone | 2172246423 |
| Mailing Fax Number | 2172211344 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2020-10-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
036-135963 | IL | Allopathic & Osteopathic Physicians |
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
2005000792 | MO | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 450 E Sigler Ave, Memphis, MO 635551726 | 2172238400 | 2172211344 |
| 927 Broadway St, Quincy, IL 623012719 | 2172246423 | 2172211344 |
| Street Address |
1102 N COUNTY ROAD 700 |
| City | WARSAW |
| State | IL |
| Zip Code | 62379-3011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013410158 | Katherine Anne Phillips | Nurse Practitioner | 1102 N County Road 700, Warsaw, IL 62379-3011 | 2018-03-15 |
| 1952461782 | Annette Yvonne Oetken | Family Medicine | 1102 N County Road 700, Warsaw, IL 62379-3011 | 2006-12-11 |
| 1528143971 | Richard Lewis O'halloran | Urology | 1102 N County Road 700, Warsaw, IL 62379-3011 | 2006-10-26 |
| 1720169899 | Dale D Zimmerman | Family Medicine | 1102 N County Road 700, Warsaw, IL 62379-3011 | 2006-10-17 |
| 1255430104 | Teresa Metzger | Nurse Practitioner | 1102 N County Road 700, Warsaw, IL 62379-3011 | 2006-09-21 |
| 1720186265 | Blessing Corporate Services | Clinic/Center | 1102 N County Road 700, Warsaw, IL 62379-3011 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295705622 | Community Health Centers of Southeastern Iowa Inc | Family Medicine | 345 Polk St, Warsaw, IL 62379-1033 | 2006-01-26 |
| 1922200484 | Warsaw Comm Unit Schl Dist 316 | Local Education Agency (LEA) | 340 S 11th St, Warsaw, IL 62379-1431 | 2007-06-05 |
| 1407074628 | Darlene Louise Young | Private Vehicle | 583 Old Warsaw Rd, Warsaw, IL 62379-3001 | 2007-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598364176 | Jace Medical LLC | Durable Medical Equipment & Medical Supplies | 3516 Commerce Dr, Warsaw, IN 46580-3925 | 2020-10-23 |
| 1982202040 | Northern Neck Regional Special Education Program | Spec/Tech, Pathology | 6914 Richmond Rd, Warsaw, VA 22572-3547 | 2020-10-12 |
| 1013523588 | Amy Deion Stitt | Nurse Practitioner | 738 E 200 N, Warsaw, IN 46582-4658 | 2020-09-21 |
| 1689280695 | Nicole Leary | Community Health Worker | 20383 State Route 79, Warsaw, OH 43844-9774 | 2020-09-16 |
| 1871104794 | Legacy Family Chiropractic LLC | Chiropractor | 550 W 300 N, Warsaw, IN 46582-6940 | 2020-08-13 |
| 1437776796 | Brandi K Shepherd | Nurse Practitioner | 1315 Fisher Ave, Warsaw, IN 46580-4810 | 2020-07-02 |
| 1659990174 | Nicole Danielle Wallick | Counselor | 2194 N Pointe Dr, Warsaw, IN 46582-9043 | 2020-04-14 |
| 1710514450 | Chad Goon | Specialist/Technologist | 1216 Meadow Ln, Warsaw, IN 46580-4114 | 2020-03-24 |
| 1992331300 | Sadye Gonnella | Nurse Practitioner | 34 Dunkin Street, Warsaw, NY 14569 | 2020-03-17 |
| 1376177212 | Sarah Lynn Stinson | Counselor | 1016 E Center St, Warsaw, IN 46580-3419 | 2020-03-01 |
| Find all providers in WARSAW | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417909888 | Tarun K Ohri | Internal Medicine | 165 Brooklyn St, Warsaw, NY 14569-1413 | 2006-05-16 |
| 1922036722 | Warsaw Health System, LLC | Internal Medicine | 2101 Dubois Dr, Warsaw, IN 46580-3210 | 2006-06-29 |
| 1255319836 | James Joseph Lanigan | Internal Medicine | 400 N Main St, Warsaw, NY 14569-1025 | 2006-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528596350 | Stat Cardiologist Inc | Internal Medicine | 2425 W 22nd St Ste 209, Oak Brook, IL 60523-4655 | 2017-05-24 |
| 1306296074 | Safwan Gaznabi | Internal Medicine | Northshore University Healthsystem, Office of Academic Affairs 2650 Ridge Ave., Suite 1304, Evanston, IL 60201 | 2016-06-14 |
| 1154796290 | Ray Jean Pensinger | Internal Medicine | 105 S. Fleming Rd., Woodstock, IL 60098-7903 | 2015-12-01 |
| 1073905311 | Cardio Medical Center Sc | Internal Medicine | 7746 West Madison Ave, Forrest Park, IL 60131 | 2015-02-24 |
| 1427457399 | Charles Joseph Frahm | Internal Medicine | 1200 E Madison Park, Chicago, IL 60615-2961 | 2014-08-17 |
| 1225447725 | Jeremy R. Estrada | Internal Medicine | 5841 S Maryland Ave # Mc5841, Chicago, IL 60637-1447 | 2014-08-08 |
| 1285049197 | Nidhi Madan | Internal Medicine | 1717 W Congress Pkwy Ste 317, Chicago, IL 60612 | 2014-06-30 |
| 1295159184 | Ca Group, LLC | Internal Medicine | 4017 Illinois Route 159, Suite 101, Smithton, IL 62285 | 2014-02-12 |
| 1457788424 | Chicago Vascular Clinic Ltd | Internal Medicine | 812 E Woodfield Rd, Schaumburg, IL 60173-4714 | 2013-10-04 |
| 1942634688 | Vein Md Consultants, LLC | Internal Medicine | 1865 N. Eltnor Blvd., West Chicago, IL 60185-5900 | 2013-08-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.