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General NPI Number Information
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NPI Number | 1629262217
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Entity Type | Organization
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Legal Business Name | ELENA M CHEBANOVA, MD, PC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 9450 E MISSISSIPPI AVE # B
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City | DENVER
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State | CO
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Zip | 80247-2307
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Country | US
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Telephone | 303-696-1395
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Fax | 303-696-1606
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Provider Business Mailing Address
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Address Line | 9450 E MISSISSIPPI AVE # B
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City | DENVER
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State | CO
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Zip | 80247-2307
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Country | US
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Telephone | 303-696-1395
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Fax | 303-696-1606
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Authorized Official
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Title or Position | OWNER/MD
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Name | MS. ELENA M CHEBANOVA
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Credential | M.D.
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Telephone | 303-696-1395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 35300
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License Number State | CO
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