Basic Information
| Provider Information | |||||||||
| NPI: | 1255645008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KALYANI | ||||||||
| FirstName: | BHARATI | ||||||||
| MiddleName: | SUKADEO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4371 E LOHMAN AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880118255 | ||||||||
| CountryCode: | IN | ||||||||
| TelephoneNumber: | 5055443299 | ||||||||
| FaxNumber: | 5756524163 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 FRUIT ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177244100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2010 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 4543 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | MD20160063 | NM | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 207X00000X | 257734 | MA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.