MEDICARE: DR. FABRICIO GUIMARAES GONCALVES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	01098281A	IN
2	2085N0700X	Neuroradiology Physician	MD478544	PA

General Provider Information

NPI Number	:	1114639242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FABRICIO GUIMARAES GONCALVES MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:	317-963-4171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N SENATE BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1239
Country	:	US
Telephone Number	:	317-962-6793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2022
Last Update Date	:	01/27/2026

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