Individual
MARIAM CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6701 FANNIN ST, HOUSTON, TX 77030-2316
(832) 822-2778
(832) 825-3141
Mailing address
6701 FANNIN ST, HOUSTON, TX 77030-2316
(832) 824-1000
(832) 825-3141
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
G6915
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136190901
—
TX
Enumeration date
10/17/2006
Last updated
07/25/2012
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