MEDICARE: DR. STEPHEN KASTOR OVERSTREET 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	207RG0100X	Gastroenterology Physician	27421	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811995624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN KASTOR OVERSTREET MD

Provider Business Mailing Address
First Line	:	4001 KRESGE WAY
Second Line	:	STE 134
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4640
Country	:	US
Telephone Number	:	502-895-0882
Fax Number	:	502-895-1354

Provider Business Practice Location Address
First Line	:	4001 KRESGE WAY
Second Line	:	STE 134
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4640
Country	:	US
Telephone Number	:	502-895-0882
Fax Number	:	502-895-1354

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	12/07/2020

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