Individual
PHILIP SONI CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(248) 514-1520
Mailing address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4674
WV
208600000X
Surgery Physician
5151014370
MI
Other
Enumeration date
03/28/2020
Last updated
06/28/2025
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