Provider Demographics
NPI:1891837787
Name:CHACKO, GEORGE N (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:N
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 1:2714 LAMOND HILL AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6979
Mailing Address - Country:US
Mailing Address - Phone:405-722-4645
Mailing Address - Fax:
Practice Address - Street 1:8224 SILVER XING
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3375
Practice Address - Country:US
Practice Address - Phone:405-722-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17461207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100827610AMedicaid
360004269OtherRAILROAD MEDICARE