Individual
ANITA CHACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
621 S NEW BALLAS RD, STE. 674A, SAINT LOUIS, MO 63141-8232
(314) 251-6831
(314) 251-5670
Mailing address
621 S NEW BALLAS RD, STE. 674A, SAINT LOUIS, MO 63141-8232
(314) 251-6831
(314) 251-5670
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
R4F01
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R4F01
MO LICENSE #
MO
Enumeration date
12/21/2005
Last updated
10/01/2007
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