Provider Demographics
NPI:1700048360
Name:CHELSEA PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:CHELSEA PROFESSIONAL SERVICES
Other - Org Name:ASSOCIATES IN UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN PRACTICE MGMT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KULAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-593-5709
Mailing Address - Street 1:515 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1504
Mailing Address - Country:US
Mailing Address - Phone:734-475-3535
Mailing Address - Fax:
Practice Address - Street 1:515 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1504
Practice Address - Country:US
Practice Address - Phone:734-475-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHU046819208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H10723OtherBCBSM
MI3408102461OtherBCBSM
MI102705381Medicaid
MIB46564Medicare UPIN
MI102705381Medicaid
MIMI1993Medicare PIN
MI596259Medicare UPIN