Healthcare Provider Details

I. General information

NPI: 1487944773
Provider Name (Legal Business Name): LUKE WILLIAM BULTHUIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 BECKNER RD LEVEL 1 POD 2 STE 1650 ORTHOPEDICS - SANTA FE
SANTA FE NM
87507-3641
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-772-2000
  • Fax: 505-772-1749
Mailing address:
  • Phone: 505-772-2000
  • Fax: 505-772-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2017-0568
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: