Provider Demographics
NPI:1073501151
Name:CHACKO, BIJU K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BIJU
Middle Name:K
Last Name:CHACKO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LAKE CAROLYN PKWY
Mailing Address - Street 2:#2101
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3932
Mailing Address - Country:US
Mailing Address - Phone:469-879-4761
Mailing Address - Fax:
Practice Address - Street 1:800 W CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3021
Practice Address - Country:US
Practice Address - Phone:972-883-2749
Practice Address - Fax:972-883-2069
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04258363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical