Provider Demographics
NPI:1114530664
Name:COMPLEX CARE OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:COMPLEX CARE OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-463-5848
Mailing Address - Street 1:508 SWEETWATER CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2131
Mailing Address - Country:US
Mailing Address - Phone:407-463-5848
Mailing Address - Fax:
Practice Address - Street 1:508 SWEETWATER CLUB CIR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2131
Practice Address - Country:US
Practice Address - Phone:407-463-5848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018470900Medicaid