Provider Demographics
NPI:1497916183
Name:BACHU, KALYAN K (MD)
Entity Type:Individual
Prefix:
First Name:KALYAN
Middle Name:K
Last Name:BACHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 W STATE ROAD 434
Mailing Address - Street 2:SUITE 2110
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5041
Mailing Address - Country:US
Mailing Address - Phone:347-853-4719
Mailing Address - Fax:
Practice Address - Street 1:2180 W STATE ROAD 434
Practice Address - Street 2:SUITE 2110
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-5041
Practice Address - Country:US
Practice Address - Phone:347-853-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107952207R00000X
NY258972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine