Individual
CHERYL CHACKO THAMARAVELIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M. D.
Contact information
Practice address
3639 HOLMES ST, DALLAS, TX 75215-3605
(972) 354-8712
(972) 354-8728
Mailing address
3639 HOLMES ST, DALLAS, TX 75215-3605
(972) 354-8712
(972) 354-8728
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
43613
KY
207Q00000X
Family Medicine Physician
Primary
P4033
TX
207VX0000X
Obstetrics Physician
P4033
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P4033
LICENSE
TX
Enumeration date
07/27/2009
Last updated
02/26/2025
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