Provider Demographics
NPI:1982199634
Name:NISSEL, CHAIM (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAIM
Middle Name:
Last Name:NISSEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:CHAIM
Other - Middle Name:LEIB BETZALEL
Other - Last Name:NISSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1065 NE 125TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5833
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:7481 W OAKLAND PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4985
Practice Address - Country:US
Practice Address - Phone:954-771-7743
Practice Address - Fax:954-771-7748
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4504207Q00000X
FLOS15435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103444700Medicaid