Basic Information
| Provider Information | |||||||||
| NPI: | 1942257092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHERVENKOFF | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | JORDANOFF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 3RD AVE NORTH | ||||||||
| Address2: | APT 104W | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012986791 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 ELM ST | ||||||||
| Address2: | VA HOSPITAL | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012393700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21653 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.