Healthcare Provider Details

I. General information

NPI: 1770701369
Provider Name (Legal Business Name): CHESTER ALFRED CHMIELEWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 BAYPORT WAY
LONGBOAT KEY FL
34228-2640
US

IV. Provider business mailing address

520 BAYPORT WAY
LONGBOAT KEY FL
34228-2640
US

V. Phone/Fax

Practice location:
  • Phone: 941-383-8762
  • Fax:
Mailing address:
  • Phone: 941-383-8762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD04433
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: