Provider Demographics
NPI:1255596581
Name:MICHELLE CHESNUT, MD, PA
Entity type:Organization
Organization Name:MICHELLE CHESNUT, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CHESNUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-432-1616
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0082207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209382902Medicaid
MO209382902Medicaid
926462671Medicare PIN