Provider Demographics
NPI:1841654688
Name:CHOBANOV, KATHERINE E (DO)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:CHOBANOV
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:CRICHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:727 N LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-1117
Mailing Address - Country:US
Mailing Address - Phone:765-569-1123
Mailing Address - Fax:
Practice Address - Street 1:727 N LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1117
Practice Address - Country:US
Practice Address - Phone:765-569-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005603A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02005603AOtherLICENSE
IN201360730Medicaid