Individual
KEVIN M OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1800 E LAKE SHORE DR, DECATUR, IL 62521-3810
(217) 464-2973
Mailing address
785 STEVENS CREEK BOULEVARD, FORSYTH, IL 62535-9741
(217) 875-0717
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-116436
IL
207P00000X
Emergency Medicine Physician
R8J38
MO
207Q00000X
Family Medicine Physician
R8J38
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036116436
—
IL
05
—
243001013
—
MO
Enumeration date
09/20/2005
Last updated
12/17/2021
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