Healthcare Provider Details

I. General information

NPI: 1447007018
Provider Name (Legal Business Name): LUKA ABASHISHVILI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date: 01/02/2025
Reactivation Date: 01/30/2025

III. Provider practice location address

MSC08 4720 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1 UNIVERSITY OF NEW MEXICO, MSC095040
ALBUQUERQUE NM
87131
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2321
  • Fax:
Mailing address:
  • Phone: 505-272-6607
  • Fax: 505-272-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2024-0137
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: