Provider Demographics
NPI:1922195999
Name:JOSEPH, KALAPPURACKAL CHACKO (MD)
Entity Type:Individual
Prefix:DR
First Name:KALAPPURACKAL
Middle Name:CHACKO
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2525 CROOKS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4733
Mailing Address - Country:US
Mailing Address - Phone:248-740-9360
Mailing Address - Fax:248-740-9374
Practice Address - Street 1:2525 CROOKS RD
Practice Address - Street 2:STE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4733
Practice Address - Country:US
Practice Address - Phone:248-740-9360
Practice Address - Fax:248-740-9374
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2016-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIKJ 0508502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2902630Medicaid
MI0631873Medicare ID - Type Unspecified
MIF10129Medicare UPIN