Basic Information
| Provider Information | |||||||||
| NPI: | 1093928004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NESSEIM | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | AUGUSTIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 N DEWEY AVE | ||||||||
| Address2: | |||||||||
| City: | REEDSBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539591098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085246477 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1900 N DEWEY AVE | ||||||||
| Address2: | |||||||||
| City: | REEDSBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085246477 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 01/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 37280 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 52599-20 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.