=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851572879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHELSEA FAMILY PHYSICIANS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2007
-----------------------------------------------------
Last Update Date | 11/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1123 S MAIN ST
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-1426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-475-9800
-----------------------------------------------------
Fax | 734-475-0918
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1123 S MAIN ST
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-1426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-475-9800
-----------------------------------------------------
Fax | 734-475-0918
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL WASHBURN SMITH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 734-475-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | MS029991
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------