Provider Demographics
NPI:1316120900
Name:CHACKO, ANJU MATHEW (MD)
Entity type:Individual
Prefix:DR
First Name:ANJU
Middle Name:MATHEW
Last Name:CHACKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:
Practice Address - Street 1:1227 MUSEUM SQUARE DR
Practice Address - Street 2:SUITE A
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4629
Practice Address - Country:US
Practice Address - Phone:281-265-8125
Practice Address - Fax:832-658-5430
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT190718207Q00000X
TXP0710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine