Individual
DAVID M CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
655 N WOODLAWN, WICHITA, KS 67208
(316) 684-5158
(316) 681-1005
Mailing address
1851 N WEBB RD, ATTN FLR2, WICHITA, KS 67206-3413
(316) 636-2010
(316) 858-3830
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
0429173
KS
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
0429173
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100143410B
—
KS
01
—
180043551
RAILROAD MEDICARE
KS
Enumeration date
12/08/2006
Last updated
01/29/2018
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