Doctor Name: | DR. MANU CHACKO |
NPI Number: | 1366704041 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 0468 |
Business Practice Address: | 1200 Briarcrest Dr Bryan, TX - 778025222 |
Business Phone Number: | 9792680786 |
Business Fax Number: | |
Mailing Address: | 8322 Cape Royal Dr, CYPRESS |
State: | TX |
Postal Code: | 774336671 |
Phone Number: | 2817048318 |
Fax Number: | |
NPI Enumeration Date: | 06/08/2012 |
NPI Last Update Date: | 06/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0468 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ZZ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |