Provider Demographics
NPI:1750395075
Name:CHELSEA PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:CHELSEA PROFESSIONAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-434-6381
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:R-6003
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-434-6381
Mailing Address - Fax:734-434-8777
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:R-6003
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-434-6381
Practice Address - Fax:734-434-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0H10810OtherBCBSM
0H16388Medicare ID - Type UnspecifiedGROUP NUMBER
MIMI1993Medicare PIN