Provider Demographics
NPI:1073736237
Name:GALANTE, GUSTAVO EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:EDUARDO
Last Name:GALANTE
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 1:322 INDIANAPOLIS BOULEVARD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375
Mailing Address - Country:US
Mailing Address - Phone:219-322-3131
Mailing Address - Fax:219-322-9494
Practice Address - Street 1:322 INDIANAPOLIS BOULEVARD
Practice Address - Street 2:SUITE 103
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375
Practice Address - Country:US
Practice Address - Phone:219-322-3131
Practice Address - Fax:219-322-9494
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038977174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000088621OtherANTHEM INSURANCE
INE81574Medicare UPIN
628820Medicare PIN