Provider Demographics
NPI:1821127333
Name:CHESNUT, MICHAEL DATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DATHAN
Last Name:CHESNUT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:9517 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9237
Mailing Address - Country:US
Mailing Address - Phone:502-214-8131
Mailing Address - Fax:502-587-3884
Practice Address - Street 1:9517 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9237
Practice Address - Country:US
Practice Address - Phone:502-767-1248
Practice Address - Fax:502-587-3884
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY40644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1821127333OtherNPI
KYCA5672Medicare PIN
KY0958Medicare PIN
KY3883Medicare PIN
KY0782Medicare PIN