Provider Demographics
NPI:1316942386
Name:CHESSER, KEITH T (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:T
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:PO BOX 85378
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5378
Mailing Address - Country:US
Mailing Address - Phone:336-274-6682
Mailing Address - Fax:336-274-8097
Practice Address - Street 1:995 9TH AVENUE
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35021
Practice Address - Country:US
Practice Address - Phone:205-481-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL241012085R0202X, 174400000X
DCME1406372085R0202X
NY3013412085R0202X
MS272182085R0202X
CAG1630882085R0202X
GA835782085R0202X
SCMD828622085R0202X
NC361592085R0202X
CT640492085R0202X
OH35.1366332085R0202X
LA3209822085R0202X
PAMD4686332085R0202X
VA01012663362085R0202X
WV292512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051503563OtherBLUE CROSS
AL171698Medicaid
AL511-60725OtherBLUE CROSS
AL051503563Medicaid
AL9338143OtherAETNA
AL051503563Medicare PIN
AL300123706Medicare PIN
AL171698Medicaid