Provider Demographics
NPI:1528450277
Name:SMITH, CHELSEA ELIZABETH
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 JOE DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1487
Mailing Address - Country:US
Mailing Address - Phone:248-778-5075
Mailing Address - Fax:
Practice Address - Street 1:3500 CALKINS RD STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3500
Practice Address - Country:US
Practice Address - Phone:810-275-0661
Practice Address - Fax:810-820-6195
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101025397208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty