1750395075 NPI number — CHELSEA PROFESSIONAL SERVICES

Table of content: (NPI 1750395075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750395075 NPI number — CHELSEA PROFESSIONAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHELSEA PROFESSIONAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTER FOR UROLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750395075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5333 MCAULEY DR
Provider Second Line Business Mailing Address:
R-6003
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48197-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-434-6381
Provider Business Mailing Address Fax Number:
734-434-8777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5333 MCAULEY DR
Provider Second Line Business Practice Location Address:
R-6003
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-434-6381
Provider Business Practice Location Address Fax Number:
734-434-8777
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISCHER
Authorized Official First Name:
C
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
734-434-6381

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0H10810 . This is a "BCBSM" identifier . This identifiers is of the category "OTHER".




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