Healthcare Provider Details

I. General information

NPI: 1255645008
Provider Name (Legal Business Name): BHARATI SUKADEO KALYANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 OSUNA RD NE
ALBUQUERQUE NM
87109-2301
US

IV. Provider business mailing address

407 HERMOSA DR SE
ALBUQUERQUE NM
87108-2615
US

V. Phone/Fax

Practice location:
  • Phone: 606-422-9158
  • Fax:
Mailing address:
  • Phone: 606-422-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberNM2016-0063
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2016-0063
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number257734
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD20160063
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4543
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: