Provider Demographics
NPI:1467477059
Name:NESSIM, MAGDOLEEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAGDOLEEN
Middle Name:
Last Name:NESSIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 W ROOSVELT RD
Mailing Address - Street 2:101
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162
Mailing Address - Country:US
Mailing Address - Phone:708-449-2648
Mailing Address - Fax:708-449-2683
Practice Address - Street 1:4413 W ROOSVELT RD
Practice Address - Street 2:101
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162
Practice Address - Country:US
Practice Address - Phone:708-449-2648
Practice Address - Fax:708-449-2683
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626619OtherBCBS
IL553290Medicare ID - Type Unspecified
IL01626619OtherBCBS