MEDICARE: DR. GEORGE N CHACKO M.D.

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	207UN0902X	Nuclear Imaging & Therapy Physician	17461	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	360004269	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891837787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE N CHACKO M.D.

Provider Business Mailing Address
First Line	:	2714 LAMOND HILL AVE
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-6979
Country	:	US
Telephone Number	:	405-722-4645
Fax Number	:

Provider Business Practice Location Address
First Line	:	8224 SILVER XING
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-3375
Country	:	US
Telephone Number	:	405-722-4645
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	03/05/2021

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