Provider Demographics
NPI:1689102998
Name:CHIRACKAL, ROBIN S (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:S
Last Name:CHIRACKAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHIRACKAL
Other - Middle Name:
Other - Last Name:ROBIN SUNNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-280-3649
Mailing Address - Fax:402-280-1237
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2319
Practice Address - Country:US
Practice Address - Phone:402-280-3649
Practice Address - Fax:402-280-1237
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10061266207Q00000X
NE8218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine