Healthcare Provider Details

I. General information

NPI: 1295771210
Provider Name (Legal Business Name): DAVID E CHAKOIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 SOUTH MAIN ST SUITE 400
VIROQUA WI
54665
US

IV. Provider business mailing address

407 SOUTH MAIN ST SUITE 400
VIROQUA WI
54665
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-4230
  • Fax: 608-637-4214
Mailing address:
  • Phone: 608-637-4230
  • Fax: 608-637-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30278
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: