Provider Demographics
NPI:1609953272
Name:KULKARNI, BHALACHANDRA A (MD)
Entity Type:Individual
Prefix:DR
First Name:BHALACHANDRA
Middle Name:A
Last Name:KULKARNI
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 1:12836 LOMAS BLVD NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6210
Mailing Address - Country:US
Mailing Address - Phone:505-298-0230
Mailing Address - Fax:505-296-0171
Practice Address - Street 1:12836 LOMAS BLVD NE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6210
Practice Address - Country:US
Practice Address - Phone:505-298-0230
Practice Address - Fax:505-296-0171
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83/234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2126704Medicare ID - Type Unspecified
NMC97908Medicare UPIN