Provider Demographics
NPI:1134269152
Name:CHELSEA MEDICINE AND LASER LLC
Entity type:Organization
Organization Name:CHELSEA MEDICINE AND LASER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ETUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-937-1980
Mailing Address - Street 1:1620 COMMERCE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1634
Mailing Address - Country:US
Mailing Address - Phone:734-475-2921
Mailing Address - Fax:734-475-2945
Practice Address - Street 1:1620 COMMERCE PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-2137
Practice Address - Country:US
Practice Address - Phone:734-475-2921
Practice Address - Fax:734-475-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012799207Q00000X
MI4301090868207R00000X
MI4301052421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty