Individual
ANITA CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2025 W NORTHERN AVE, PHOENIX, AZ 85021-5157
(602) 655-6300
Mailing address
2601 E ROOSEVELT ST, PHOENIX, AZ 85008-4973
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
009860
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/02/2019
Last updated
08/18/2023
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