Healthcare Provider Details

I. General information

NPI: 1508863176
Provider Name (Legal Business Name): ROBERT J CHESSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 24TH ST STE 125
ROCK ISLAND IL
61201-5394
US

IV. Provider business mailing address

2570 24TH ST STE 125
ROCK ISLAND IL
61201-5394
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-2011
  • Fax: 309-779-2815
Mailing address:
  • Phone: 309-779-2011
  • Fax: 309-779-2815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036058383
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number23454
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: