MEDICARE: DR. ANGELO GREGORY CHACHAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	5951382-1205	UT
2	208600000X	Surgery Physician	5951382-1205	UT

General Provider Information

NPI Number	:	1194726232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELO GREGORY CHACHAS MD

Provider Business Mailing Address
First Line	:	PO BOX 100253
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-0253
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E 3900 S
Second Line	:	STE 460
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1348
Country	:	US
Telephone Number	:	801-262-3564
Fax Number	:	801-262-3613

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	01/31/2022

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