Chebotarev, Oleg

Chebotarev, Oleg is an individual health care provider with primary practice located at 1818 N Meade St , Appleton WI 54911-3454. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Chebotarev, Oleg can be contacted via phone (920) 731-8900.

Contact Information

Primary practice address
1818 N Meade St Appleton WI 54911-3454
Phone: (920) 731-8900
Fax: (920) 738-5369
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 25MA08401100 New Jersey
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 21600 Wisconsin

Profile Details

NPI number 1780647552
LBN Legal business name Chebotarev, Oleg
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 11th, 2006
Last updated Jan 12th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780647552 NPPES
Other 223052989 TAX ID
MEDICAID 0163431 TAX ID

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