| Doctor Name: | DR. CHACKO NEBU |
| NPI Number: | 1538439559 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME 111310 |
| Business Practice Address: | 2401 Frist Boulevard Suite One Fort Pierce, FL - 34950 |
| Business Phone Number: | 7724640033 |
| Business Fax Number: | 7724671150 |
| Mailing Address: | 2401 First Boulevard , Suite One, Internal Medicine Consultants FORT PIERCE, |
| State: | FL |
| Postal Code: | 34950 |
| Phone Number: | 7724640033 |
| Fax Number: | 7724671150 |
| NPI Enumeration Date: | 01/06/2012 |
| NPI Last Update Date: | 10/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME 111310 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |