Healthcare Provider Details

I. General information

NPI: 1063459311
Provider Name (Legal Business Name): GRAHAM T CHELIUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR STE 103
UKIAH CA
95482-4568
US

IV. Provider business mailing address

PO BOX 414
WAIMEA HI
96796-0414
US

V. Phone/Fax

Practice location:
  • Phone: 707-467-3123
  • Fax: 707-462-3063
Mailing address:
  • Phone: 808-639-7892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40674
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15006
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5282
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC195808
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC195808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: