KENNETH RICHARD NISSIM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

ACTIVE

Business

Title

First Name

KENNETH

Middle

RICHARD

Last Name

NISSIM

Business Name

KENNETH RICHARD NISSIM MD

Original Issue Date

07/02/2024

Effective Date

07/02/2024

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/02/2024