MEDICARE: DR. GEORGE E OVERLY 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	207Q00000X	Family Medicine Physician	4301052054	MI

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	:	1962403709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE E OVERLY MD

Provider Business Mailing Address
First Line	:	800 E ELLIS RD
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5622
Country	:	US
Telephone Number	:	231-798-9840
Fax Number	:	231-798-9740

Provider Business Practice Location Address
First Line	:	800 E ELLIS RD
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5622
Country	:	US
Telephone Number	:	231-798-9840
Fax Number	:	231-798-9740

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	01/04/2012

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