Provider Demographics
NPI:1114078698
Name:CHABAN, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:CHABAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S HUNT CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4947
Mailing Address - Country:US
Mailing Address - Phone:407-786-4080
Mailing Address - Fax:407-786-4667
Practice Address - Street 1:425 S HUNT CLUB BLVD STE 1051
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-2428
Practice Address - Country:US
Practice Address - Phone:407-786-4080
Practice Address - Fax:407-786-4667
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68094208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263339600Medicaid