Provider Demographics
NPI:1053527184
Name:CHACKO, RON J (MD)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:J
Last Name:CHACKO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:213 N RACINE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1644
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:7000 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2112
Practice Address - Country:US
Practice Address - Phone:708-484-8090
Practice Address - Fax:708-445-4444
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.126315207Q00000X
CAA107917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400139202OtherMEDICARE PTAN