Provider Demographics
NPI:1578741252
Name:INTEGRATED HEALTH CARE OF CHELSEA, P.C.
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CARE OF CHELSEA, P.C.
Other - Org Name:INTEGRATED HEALTH CARE OF CHELSEA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GLEESPEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-475-1107
Mailing Address - Street 1:1290 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1454
Mailing Address - Country:US
Mailing Address - Phone:734-475-1107
Mailing Address - Fax:734-475-9230
Practice Address - Street 1:1290 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1454
Practice Address - Country:US
Practice Address - Phone:734-475-1107
Practice Address - Fax:734-475-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMG048067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3253813 TYPE 10Medicaid
MIMG048067OtherSTATE LICENSE
MIMG048067OtherSTATE LICENSE
A73223Medicare UPIN