Provider Demographics
NPI:1891724027
Name:CHEBANOVA, ELENA M (MD)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:M
Last Name:CHEBANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9450 E MISSISSIPPI AVE
Mailing Address - Street 2:#B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2307
Mailing Address - Country:US
Mailing Address - Phone:303-696-1376
Mailing Address - Fax:303-696-1606
Practice Address - Street 1:9450 E MISSISSIPPI AVE
Practice Address - Street 2:#B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2307
Practice Address - Country:US
Practice Address - Phone:303-696-1376
Practice Address - Fax:303-696-1606
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO35300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01353002Medicaid
CO01353002Medicaid
C17631Medicare ID - Type Unspecified
G36558Medicare UPIN