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General NPI Number Information
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NPI Number | 1821127333
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Entity Type | Individual
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Provider Name | MICHAEL DATHAN CHESNUT M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 9517 US HIGHWAY 42
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City | PROSPECT
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State | KY
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Zip | 40059-9237
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Country | US
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Telephone | 502-767-1248
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Fax | 502-587-3884
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Provider Business Mailing Address
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Address Line | 9517 US HIGHWAY 42
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City | PROSPECT
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State | KY
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Zip | 40059-9237
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Country | US
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Telephone | 502-214-8131
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Fax | 502-587-3884
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 40644
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License Number State | KY
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