Basic Information
| Provider Information | |||||||||
| NPI: | 1649629510 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUTHER | ||||||||
| FirstName: | CHELSEA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43151 DALCOMA DR STE 4 | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480386306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862868720 | ||||||||
| FaxNumber: | 5866496699 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 N LILLEY RD | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481873907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344951506 | ||||||||
| FaxNumber: | 7344951780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2016 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 4301110305 | MI | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.