Provider Demographics
NPI:1679731665
Name:CHACKO, CHRIS E (MD)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:E
Last Name:CHACKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-425-2646
Mailing Address - Fax:812-467-7209
Practice Address - Street 1:350 W. COLUMBIA, SUITE 310
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1782
Practice Address - Country:US
Practice Address - Phone:812-425-2646
Practice Address - Fax:812-467-7209
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11012804A207Y00000X
IN01064628-A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200992660Medicaid
IN200992660Medicaid