Provider Demographics
NPI:1881681484
Name:CHACKO, MONA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:CHACKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 STONEBROOOK PKWY
Mailing Address - Street 2:# 100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-712-1911
Mailing Address - Fax:
Practice Address - Street 1:8200 STONEBROOK PKWY
Practice Address - Street 2:# 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5539
Practice Address - Country:US
Practice Address - Phone:972-712-1911
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610144Medicare ID - Type Unspecified
TXH98210Medicare UPIN