Provider Demographics
NPI:1396163630
Name:CHABAN, CHRISTIAN ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ALEXANDER
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 1:1180 SWEETWATER CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2211
Mailing Address - Country:US
Mailing Address - Phone:407-463-5848
Mailing Address - Fax:407-788-8504
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?:No
Enumeration Date:2014-04-03
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129304208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018470900Medicaid