Provider Demographics
NPI:1770701369
Name:CHMIELEWSKI, CHESTER ALFRED (MD)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:ALFRED
Last Name:CHMIELEWSKI
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 1:520 BAYPORT WAY
Mailing Address - Street 2:
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-2640
Mailing Address - Country:US
Mailing Address - Phone:941-383-8762
Mailing Address - Fax:
Practice Address - Street 1:520 BAYPORT WAY
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-2640
Practice Address - Country:US
Practice Address - Phone:941-383-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD04433207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7000377Medicaid
RI7000377Medicaid