MEDICARE: LEENA CHACKO M.D P.A

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1609002138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEENA CHACKO M.D P.A

Provider Business Mailing Address
First Line	:	PO BOX 131083
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77393-1083
Country	:	US
Telephone Number	:	832-585-7967
Fax Number	:

Provider Business Practice Location Address
First Line	:	17320 RED OAK DR STE 260
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2643
Country	:	US
Telephone Number	:	936-242-1728
Fax Number	:	936-447-9145

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEENA CHACKO
Credential	:	M.D
Telephone Number	:	936-242-1728

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	04/25/2020

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