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NPI Code Detail

MEDICARE: KEVIN M OLIVER DO

MEDICARE: KEVIN M OLIVER DO
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
1207P00000XEmergency Medicine PhysicianR8J38MO
2207Q00000XFamily Medicine PhysicianR8J38MO
3207P00000XEmergency Medicine Physician036-116436IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477549020
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN M OLIVER DO
Provider Business Mailing Address
First Line : 785 STEVENS CREEK BOULEVARD
Second Line :
City : FORSYTH
State : IL
Zip : 62535-9741
Country : US
Telephone Number : 217-875-0717
Fax Number :
Provider Business Practice Location Address
First Line : 1800 E LAKE SHORE DR
Second Line :
City : DECATUR
State : IL
Zip : 62521-3810
Country : US
Telephone Number : 217-464-2973
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 12/17/2021

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Directions to “ KEVIN M OLIVER DO” Practice Location

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