Provider Demographics
NPI:1275537839
Name:CHESIS, PAUL L (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:CHESIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1675 E MAIN ST
Mailing Address - Street 2:BOX 328
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-5818
Mailing Address - Country:US
Mailing Address - Phone:330-593-1049
Mailing Address - Fax:330-572-3836
Practice Address - Street 1:1675 E MAIN ST
Practice Address - Street 2:BOX 328
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-5818
Practice Address - Country:US
Practice Address - Phone:330-593-1049
Practice Address - Fax:330-572-3836
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.1229332085R0204X
MOR5P252085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100285030CMedicaid
MOP00475725OtherRAILROAD MEDICARE
KS100285030EMedicaid
MO23979028OtherBCBS OF KC MO
KS100285030DMedicaid
OH0098946Medicaid
MO23979118OtherBCBS KC GRP#18959016
MO203108634Medicaid
MO203108634Medicaid
KS100285030CMedicaid
OHH287310Medicare PIN
MOJ969902Medicare PIN
MO23979028OtherBCBS OF KC MO
MOY029902Medicare PIN
MOJ969902BMedicare PIN
MOP00475725OtherRAILROAD MEDICARE