| Doctor Name: | MR. BIJU K CHACKO |
| NPI Number: | 1073501151 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.A.-C |
| License Number: | PA04258 |
| Business Practice Address: | 2727 Bolton Boone Dr Suite 105 Desoto, TX - 751152019 |
| Business Phone Number: | 9722963875 |
| Business Fax Number: | 9722963575 |
| Mailing Address: | 1000 Lake Carolyn Pkwy, #2101 IRVING |
| State: | TX |
| Postal Code: | 750393932 |
| Phone Number: | 4698794761 |
| Fax Number: | |
| NPI Enumeration Date: | 10/12/2005 |
| NPI Last Update Date: | 06/12/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA04258 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |