Basic Information
| Provider Information | |||||||||
| NPI: | 1619937158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOBANOV | ||||||||
| FirstName: | ZELJKA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 EATON AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450132716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376439299 | ||||||||
| FaxNumber: | 9376432343 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 EATON AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450132716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376439299 | ||||||||
| FaxNumber: | 9376432343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD00045930 | WA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | C55168 | CA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 35.136454 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0363309 | 05 | OH | MEDICAID | 1619937158 | 05 | CA | MEDICAID | 0207955 | 01 | WA | L&I/CRIME VICTIMS | OTHER |