Individual
SERENA M CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
2018-00738
NC
2085R0202X
Diagnostic Radiology Physician
Primary
4301511806
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184987521
—
NC
Enumeration date
06/20/2012
Last updated
09/06/2024
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