Provider Demographics
NPI:1639136484
Name:OVERCASH, LARRY F (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:F
Last Name:OVERCASH
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 1:7309 N KNOXVILLE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2085
Mailing Address - Country:US
Mailing Address - Phone:309-671-5100
Mailing Address - Fax:309-671-5155
Practice Address - Street 1:7309 N KNOXVILLE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2085
Practice Address - Country:US
Practice Address - Phone:309-671-5100
Practice Address - Fax:309-671-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072608207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360726082Medicaid
ILP10907Medicare ID - Type Unspecified
ILC43668Medicare UPIN