Basic Information
| Provider Information | |||||||||
| NPI: | 1275537839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHESIS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1675 E MAIN ST | ||||||||
| Address2: | BOX 328 | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442405818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305931049 | ||||||||
| FaxNumber: | 3305723836 | ||||||||
| Practice Location | |||||||||
| Address1: | 1675 E MAIN ST | ||||||||
| Address2: | BOX 328 | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442405818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305931049 | ||||||||
| FaxNumber: | 3305723836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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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 | 2085R0204X | 35.122933 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 100285030C | 05 | KS | MEDICAID | P00475725 | 01 | MO | RAILROAD MEDICARE | OTHER | 100285030E | 05 | KS | MEDICAID | 23979028 | 01 | MO | BCBS OF KC MO | OTHER | 100285030D | 05 | KS | MEDICAID | 0098946 | 05 | OH | MEDICAID | 23979118 | 01 | MO | BCBS KC GRP#18959016 | OTHER | 203108634 | 05 | MO | MEDICAID |