Provider Demographics
NPI:1265676654
Name:OVERHOLSER, STEPHEN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:OVERHOLSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-3400
Mailing Address - Country:US
Mailing Address - Phone:952-927-6501
Mailing Address - Fax:833-905-0988
Practice Address - Street 1:7500 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-3400
Practice Address - Country:US
Practice Address - Phone:952-927-6501
Practice Address - Fax:833-905-0988
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85052208800000X
MN72170208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology