MEDICARE: GUSTAVO HENRIQUE BARBOSA DE ANDRADE DDS, MD, PHD

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	1223P0700X	Prosthodontics	85140-875	WI

General Provider Information

NPI Number	:	1184410235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO HENRIQUE BARBOSA DE ANDRADE DDS, MD, PHD

Provider Business Mailing Address
First Line	:	1801 W WISCONSIN AVE OFC 316
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2186
Country	:	US
Telephone Number	:	414-288-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 W WISCONSIN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2186
Country	:	US
Telephone Number	:	146-851-2444
Fax Number	:

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

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	02/04/2026

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