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NPI Code Detail

MEDICARE: MAXIM A. CHASANOV M.D.

MEDICARE: MAXIM A. CHASANOV M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianME153055FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124028584
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAXIM A. CHASANOV M.D.
Provider Business Mailing Address
First Line : 6075 BATHEY LN
Second Line :
City : NAPLES
State : FL
Zip : 34116-7536
Country : US
Telephone Number : 239-455-8500
Fax Number : 239-455-6561
Provider Business Practice Location Address
First Line : 6075 BATHEY LN
Second Line :
City : NAPLES
State : FL
Zip : 34116-7536
Country : US
Telephone Number : 239-455-8500
Fax Number : 239-455-6561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 03/19/2025

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