Provider Demographics
NPI:1578137246
Name:BACELAR FONTENELE ARAUJO, GUSTAVO (MD)
Entity Type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:
Last Name:BACELAR FONTENELE ARAUJO
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 1:12 KIMBER LANE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715
Mailing Address - Country:US
Mailing Address - Phone:812-304-7490
Mailing Address - Fax:
Practice Address - Street 1:520 S. 7TH STREET
Practice Address - Street 2:
Practice Address - City:VINCENNESS
Practice Address - State:IN
Practice Address - Zip Code:47591
Practice Address - Country:US
Practice Address - Phone:812-885-8520
Practice Address - Fax:812-885-6991
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11022011A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine