Healthcare Provider Details

I. General information

NPI: 1770817124
Provider Name (Legal Business Name): JOSEPH CHACKO VALAYAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEMON CHACKO VALAYAM MD

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 WOODLAND DR SUITE A
ELIZABETHTOWN KY
42701-2651
US

IV. Provider business mailing address

1324 WOODLAND DR SUITE A
ELIZABETHTOWN KY
42701-2651
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-5921
  • Fax:
Mailing address:
  • Phone: 270-765-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number45063
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number45063
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: