Individual
CARLOS A GAMBIRAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2479
(765) 448-8000
(765) 448-7624
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01046677A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000282913
ANTHEM PROVIDER NUMBER
IN
05
—
200145840
—
IN
01
—
8155500582
MEDICARE PTAN
IN
Enumeration date
03/14/2006
Last updated
10/17/2023
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