Individual
DR. OLEG CHEBOTAREV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1818 N MEADE ST, APPLETON, WI 54911-3454
(920) 731-8900
(920) 738-5369
Mailing address
2073 KLOCKNER RD, HAMILTON, NJ 08690-3414
(609) 584-1212
(609) 584-0103
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
21600
WI
207RC0000X
Cardiovascular Disease Physician
25MA08401100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0163431
—
NJ
01
—
223052989
TAX ID
—
Enumeration date
04/11/2006
Last updated
01/12/2022
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