Provider Demographics
NPI:1265528509
Name:EMKO, CHOOKIERT (MD)
Entity type:Individual
Prefix:MR
First Name:CHOOKIERT
Middle Name:
Last Name:EMKO
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 1:21 NORTH LOVE STREET
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351
Mailing Address - Country:US
Mailing Address - Phone:850-627-9563
Mailing Address - Fax:850-875-2992
Practice Address - Street 1:21 NORTH LOVE STREET
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351
Practice Address - Country:US
Practice Address - Phone:850-627-9563
Practice Address - Fax:850-875-2992
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022076208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0022076Medicaid
FL20040Medicare ID - Type Unspecified
FLME0022076Medicaid