1023077518 NPI number — DR. TAMY S CHELST PHD

Table of content: DR. TAMY S CHELST PHD (NPI 1023077518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023077518 NPI number — DR. TAMY S CHELST PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHELST
Provider First Name:
TAMY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1023077518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22536 N BELLWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-2115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-357-6879
Provider Business Mailing Address Fax Number:
248-353-2268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22536 N BELLWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-357-6879
Provider Business Practice Location Address Fax Number:
248-353-2268
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  572 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 000173 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 1601000156 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 640003157 . This is a "PALMETTO GBA-RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: AD0043 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5102839 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 711249 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 792556 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0F32633 . This is a "HEALTH ALLIANCE PLAN(HAP)" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1506196 . This is a "UMWA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 804697126 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87945 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 640002190 . This is a "PALMETTO GBA-RAILROAD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 640F32633 . This is a "BCBS MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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