Provider Demographics
NPI:1508863176
Name:CHESSER, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:CHESSER
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 1:2570 24TH ST
Mailing Address - Street 2:STE 125
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5394
Mailing Address - Country:US
Mailing Address - Phone:309-779-2011
Mailing Address - Fax:309-779-2815
Practice Address - Street 1:2570 24TH ST
Practice Address - Street 2:STE 125
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5394
Practice Address - Country:US
Practice Address - Phone:309-779-2011
Practice Address - Fax:309-779-2815
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058383208100000X
IA23454208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01136858OtherRR MEDICARE
IL036058383Medicaid
IA0930263Medicaid
IA1508863176Medicaid
IAP01278237OtherRR MEDICARE
IA1508863176Medicaid
IL036058383Medicaid
IL200715041Medicare PIN
IAP01278237OtherRR MEDICARE
IA0930263Medicaid