Provider Demographics
NPI:1346200888
Name:BURKETT, CHESTER ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:ROBERT
Last Name:BURKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:POSEYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47633
Mailing Address - Country:US
Mailing Address - Phone:812-874-2228
Mailing Address - Fax:812-845-2510
Practice Address - Street 1:40 W FLETCHALL ST
Practice Address - Street 2:
Practice Address - City:POSEYVILLE
Practice Address - State:IN
Practice Address - Zip Code:47633-9015
Practice Address - Country:US
Practice Address - Phone:812-874-2228
Practice Address - Fax:812-845-2510
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100246920AMedicaid
IN100246920AMedicaid
INBU847130Medicare ID - Type Unspecified