Provider Demographics
NPI:1891225256
Name:CHACKO ACHANARIL, ANOOP (MBBS)
Entity Type:Individual
Prefix:
First Name:ANOOP
Middle Name:
Last Name:CHACKO ACHANARIL
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 W CONGRESS PKWY # 181
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-4184
Mailing Address - Fax:312-942-7246
Practice Address - Street 1:1653 W. CONGRESS PARKWAY, JELKE 181
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-962-4186
Practice Address - Fax:312-962-7264
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL1250718412085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program