Provider Demographics
NPI:1063459311
Name:CHELIUS, GRAHAM T (MD)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:T
Last Name:CHELIUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0414
Mailing Address - Country:US
Mailing Address - Phone:808-639-7892
Mailing Address - Fax:
Practice Address - Street 1:260 HOSPITAL DR STE 103
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4568
Practice Address - Country:US
Practice Address - Phone:707-467-3123
Practice Address - Fax:707-462-3063
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40674207Q00000X
HI15006207Q00000X
AK5282207Q00000X
CAC195808208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD8641Medicaid
AKI03279Medicare UPIN
AKMD8641Medicaid