Healthcare Provider Details

I. General information

NPI: 1467907782
Provider Name (Legal Business Name): KALYANI ORTHOPAEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

IV. Provider business mailing address

2842 LOOKOUT RIDGE DR
LAS CRUCES NM
88011-0813
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 Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BHARATI SUKADEO KALYANI
Title or Position: ORTHOPAEDIC SURGEON
Credential: MD
Phone: 606-422-9158