Provider Demographics
NPI:1245461177
Name:THAMARAVELIL, CHERYL CHACKO (M D)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:CHACKO
Last Name:THAMARAVELIL
Suffix:
Gender:
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3639 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-3605
Mailing Address - Country:US
Mailing Address - Phone:972-354-8712
Mailing Address - Fax:972-354-8728
Practice Address - Street 1:3639 HOLMES ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-3605
Practice Address - Country:US
Practice Address - Phone:972-354-8712
Practice Address - Fax:972-354-8728
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY43613207Q00000X
TXP4033207VX0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP4033OtherLICENSE