Provider Demographics
NPI:1316998081
Name:CHAKKO, SIMON C (MD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:C
Last Name:CHAKKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1201, NW 16 ST
Mailing Address - Street 2:V.A.MEDICAL CENTER-111A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1624
Mailing Address - Country:US
Mailing Address - Phone:305-575-3182
Mailing Address - Fax:305-575-3116
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:V.A.MEDICAL CENTER- 111A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-575-3182
Practice Address - Fax:305-575-3116
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME55081207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D84969Medicare UPIN