Individual
DR. CHACKO NEBU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7025 OLEANDER AVE, PORT ST LUCIE, FL 34952-9028
(609) 744-4133
(772) 882-5166
Mailing address
8450 S US HIGHWAY 1, PORT ST LUCIE, FL 34952-3306
(772) 871-0055
(772) 365-0456
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME111310
FL
208D00000X
General Practice Physician
ME 111310
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004776500
—
FL
Enumeration date
01/06/2012
Last updated
01/27/2025
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