Provider Demographics
NPI:1760411979
Name:CHESNUT, MICHELLE N (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:N
Last Name:CHESNUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:N
Other - Last Name:LAKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8210 WALNUT HILL LN
Mailing Address - Street 2:SUITE 314
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4405
Mailing Address - Country:US
Mailing Address - Phone:214-432-1616
Mailing Address - Fax:214-432-1617
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:SUITE 314
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4405
Practice Address - Country:US
Practice Address - Phone:214-432-1616
Practice Address - Fax:214-432-1617
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024746207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209382902Medicaid
MO926462671Medicare PIN
MOI25196Medicare UPIN
MO926464992Medicare PIN