Healthcare Provider Details

I. General information

NPI: 1114078698
Provider Name (Legal Business Name): CARLOS CHABAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S HUNT CLUB BLVD STE 1051
APOPKA FL
32703-2428
US

IV. Provider business mailing address

425 S HUNT CLUB BLVD
APOPKA FL
32703-4947
US

V. Phone/Fax

Practice location:
  • Phone: 407-786-4080
  • Fax: 407-786-4667
Mailing address:
  • Phone: 407-786-4080
  • Fax: 407-786-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME68094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: