Healthcare Provider Details

I. General information

NPI: 1225785843
Provider Name (Legal Business Name): MR. THOMAS OVERETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 W M 32
GAYLORD MI
49735-9287
US

IV. Provider business mailing address

2329 CENTER ST
BOYNE FALLS MI
49713-9268
US

V. Phone/Fax

Practice location:
  • Phone: 231-751-0070
  • Fax:
Mailing address:
  • Phone: 231-758-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: