Individual
WYNTON B OVERCAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 741-1515
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01090269A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300025547
—
IN
01
—
959090191
MEDICARE PTAN
IN
Enumeration date
03/30/2018
Last updated
09/15/2023
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