Healthcare Provider Details

I. General information

NPI: 1043741432
Provider Name (Legal Business Name): SUJATA MULEKAR CHOUINARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 COAL AVE SE
ALBUQUERQUE NM
87106-5205
US

IV. Provider business mailing address

6320 RIVERSIDE PLAZA LN NW STE B
ALBUQUERQUE NM
87120-1710
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-6168
  • Fax: 505-792-1978
Mailing address:
  • Phone: 505-843-6168
  • Fax: 505-792-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2021-0194
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: