Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 10740A | WY |
N | 111NI0900X | Internist | 10740A | WY |
N | 207R00000X | Internist | 125058582 | IL |
N | 111NI0900X | Internist | 125058582 | IL |
N | 207R00000X | Internist | DR.0057114 | CO |
N | 111NI0900X | Internist | DR.0057114 | CO |
N | 207RC0000X | Internist - Cardiovascular Disease | 036132053 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 10740A | WY |
Y | 207RC0000X | Internist - Cardiovascular Disease | DR.0057114 | CO |
N | 207U00000X | Nuclear Medicine Specialist | 10740A | WY |
NPI | 1104147560 |
---|---|
Provider Name | Dr. Satish Jacob Chacko |
First Address | Fort Collins, CO 80528-3400 |
Second Address | Fort Collins, CO 80528-3400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2010 |
Last Update Date | 02/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01205234 | (05) | CO |
DR.0057114 | STATE MEDICAL LICENSE (01) | CO |