Provider Demographics
NPI:1649629510
Name:LUTHER, CHELSEA (MD)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:LUTHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43151 DALCOMA DR STE 4
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6306
Mailing Address - Country:US
Mailing Address - Phone:586-286-8720
Mailing Address - Fax:586-649-6699
Practice Address - Street 1:285 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3907
Practice Address - Country:US
Practice Address - Phone:734-495-1506
Practice Address - Fax:734-495-1780
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301110305207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301110305Medicaid