Provider Demographics
NPI:1619916848
Name:OVERMAN, DAVID MILLER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MILLER
Last Name:OVERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2530 CHICAGO AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4291
Mailing Address - Country:US
Mailing Address - Phone:612-813-8800
Mailing Address - Fax:612-813-8825
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:STE 500
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4291
Practice Address - Country:US
Practice Address - Phone:612-813-8800
Practice Address - Fax:612-813-8825
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33317207RC0000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN400707700Medicaid
WI31821500Medicaid
MN020001903Medicare ID - Type Unspecified
MNF29004Medicare UPIN