Organization
CHESTNUT HEALTH OF MISSOURI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAI KUMAR (ADMINISTRATOR)
(703) 348-6060
Entity
Organization
Contact information
Practice address
13700 OLD HALLS FERRY RD, BLACK JACK, MO 63033-4109
(314) 355-0760
(703) 649-6188
Mailing address
1530 N RANDALL RD STE 210, ELGIN, IL 60123-7879
(703) 348-6060
(703) 649-6188
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
11/11/2024
Last updated
11/11/2024
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