Healthcare Provider Details

I. General information

NPI: 1538720628
Provider Name (Legal Business Name): CHELSEY LYNNE WALQUIST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 KALAMAZOO AVE SE STE A
CALEDONIA MI
49316-9197
US

IV. Provider business mailing address

7150 KALAMAZOO AVE SE STE A
CALEDONIA MI
49316-9197
US

V. Phone/Fax

Practice location:
  • Phone: 616-818-7454
  • Fax: 616-818-7455
Mailing address:
  • Phone: 616-818-7454
  • Fax: 616-818-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351045584
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: