MEDICARE: DR. PAUL L CHESIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician	35.122933	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00475725	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	23979028	OTHER	MO	BCBS OF KC MO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	23979118	OTHER	MO	BCBS KC GRP#18959016
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275537839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL L CHESIS MD

Provider Business Mailing Address
First Line	:	1675 E MAIN ST
Second Line	:	BOX 328
City	:	KENT
State	:	OH
Zip	:	44240-5818
Country	:	US
Telephone Number	:	330-593-1049
Fax Number	:	330-572-3836

Provider Business Practice Location Address
First Line	:	1675 E MAIN ST
Second Line	:	BOX 328
City	:	KENT
State	:	OH
Zip	:	44240-5818
Country	:	US
Telephone Number	:	330-593-1049
Fax Number	:	330-572-3836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/29/2016

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Directions to “ DR. PAUL L CHESIS MD” Practice Location

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