Healthcare Provider Details

I. General information

NPI: 1982142543
Provider Name (Legal Business Name): KARA CHANKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 SOUTHWEST FWY SUITE 410
HOUSTON TX
77027-7313
US

IV. Provider business mailing address

4141 SOUTHWEST FWY SUITE 410
HOUSTON TX
77027-7313
US

V. Phone/Fax

Practice location:
  • Phone: 713-255-5097
  • Fax: 713-626-2337
Mailing address:
  • Phone: 713-255-5097
  • Fax: 713-626-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number5282
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: