Individual
MICHAEL C OVERDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11104 PARKVIEW CIRCLE DR, SUITE 410, FORT WAYNE, IN 46845-1672
(260) 266-5260
(260) 266-5269
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
01042341
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000576774
ANTHEM
IN
01
—
000000670288
ANTHEM
IN
05
—
200015210
—
IN
01
—
P00685770
RR MEDICARE
IN
Enumeration date
05/19/2006
Last updated
10/07/2022
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