Provider Demographics
NPI:1295750883
Name:NESSIM, WAGIH (MD)
Entity type:Individual
Prefix:MR
First Name:WAGIH
Middle Name:
Last Name:NESSIM
Suffix:
Gender:M
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 ROOSEVELT RD
Mailing Address - Street 2:#101
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-2074
Mailing Address - Country:US
Mailing Address - Phone:708-449-2648
Mailing Address - Fax:708-449-2683
Practice Address - Street 1:4413 ROOSEVELT RD
Practice Address - Street 2:#101
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-2074
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
IL3647031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047031Medicaid
C42094Medicare UPIN
479210Medicare ID - Type Unspecified