MEDICARE: DR. KIMBERLEE H OVERDECK 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	036-134226	IL
2	2085R0202X	Diagnostic Radiology Physician	D0061784	MD
3	2085R0202X	Diagnostic Radiology Physician	0101240648	VA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447240155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLEE H OVERDECK MD

Provider Business Mailing Address
First Line	:	111 OAKWOOD RD
Second Line	:
City	:	EAST PEORIA
State	:	IL
Zip	:	61611-1853
Country	:	US
Telephone Number	:	309-740-4272
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 SHIPMAN LANE
Second Line	:
City	:	MCLEAN
State	:	VA
Zip	:	22101-2137
Country	:	US
Telephone Number	:	703-556-6466
Fax Number	:	703-556-8881

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	11/27/2023

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