Individual
MONTRIE CHAKSUPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5381
(740) 446-5082
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5387
(740) 446-5082
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
35-10-0192
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000007452
ANTHEM BCBS
—
01
—
000000181427
UNISON MEDICAID
OH
01
—
001714040
MOUNTAIN STATE BCBS
—
05
—
0092684000
—
WV
01
—
0235203
MOLINA MEDICAID
OH
01
—
160017398
RR MEDICARE
—
01
—
310917085090
CARESOURCE MEDICAID
OH
Enumeration date
05/17/2006
Last updated
08/07/2014
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