Provider Demographics
NPI:1063459311
Name:CHELIUS, GRAHAM T (MD)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:T
Last Name:CHELIUS
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 669
Mailing Address - Street 2:4643B WAIMEA CANYON RD
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0669
Mailing Address - Country:US
Mailing Address - Phone:808-338-8311
Mailing Address - Fax:808-338-0225
Practice Address - Street 1:4643B WAIMEA CANYON RD
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796-0669
Practice Address - Country:US
Practice Address - Phone:808-338-8311
Practice Address - Fax:808-338-0225
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5282207Q00000X
HI15006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD8641Medicaid
AKI03279Medicare UPIN
AKMD8641Medicaid