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Individual

DR. CHOWALLUR DEV CHACKO

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2718 N ORANGE AVE, SUITE C, ORLANDO, FL 32804-7611
(407) 894-2664
(407) 894-2450
Mailing address
2718 N ORANGE AVE, SUITE C, ORLANDO, FL 32804-7611
(407) 894-2664
(407) 894-2450

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0034022
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ME0034022
STATE LICENSE
FL
Enumeration date
07/28/2005
Last updated
07/08/2007
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