Healthcare Provider Details

I. General information

NPI: 1114576337
Provider Name (Legal Business Name): CHELSEA PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W BENNETT ST
SALINE MI
48176-1105
US

IV. Provider business mailing address

44428 WOODWARD AVE STE 101
PONTIAC MI
48341-5009
US

V. Phone/Fax

Practice location:
  • Phone: 734-429-9377
  • Fax: 734-429-8277
Mailing address:
  • Phone: 248-858-3015
  • Fax: 248-858-6232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PAUL GUSHO
Title or Position: CFO, MICHIGAN REGION
Credential:
Phone: 248-858-6174