| Doctor Name: | MICHAEL A NISSENBAUM |
| NPI Number: | 1356328975 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 014984 |
| Business Practice Address: | 194 East Main Street Fort Kent, ME - 04743 |
| Business Phone Number: | 2078343155 |
| Business Fax Number: | 2078343040 |
| Mailing Address: | Po Box 1849, LEWISTON |
| State: | ME |
| Postal Code: | 042411849 |
| Phone Number: | 2077842554 |
| Fax Number: | 2077775363 |
| NPI Enumeration Date: | 12/23/2005 |
| NPI Last Update Date: | 09/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 014984 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |