Provider Demographics
NPI:1487710240
Name:CHELSEA VILLAGE FAMILY MEDICINE, P.C.
Entity type:Organization
Organization Name:CHELSEA VILLAGE FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JUNGHO
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-475-3662
Mailing Address - Street 1:1600 COMMERCE PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1620
Mailing Address - Country:US
Mailing Address - Phone:734-475-3662
Mailing Address - Fax:734-475-4232
Practice Address - Street 1:1600 COMMERCE PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1620
Practice Address - Country:US
Practice Address - Phone:734-475-3662
Practice Address - Fax:734-475-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH16709Medicare UPIN