Provider Demographics
NPI:1740576529
Name:OVERPECK, CALEB ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:ROBERT
Last Name:OVERPECK
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 1:14745 W COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47334-9513
Mailing Address - Country:US
Mailing Address - Phone:765-213-6390
Mailing Address - Fax:
Practice Address - Street 1:14745 W COMMERCE RD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:IN
Practice Address - Zip Code:47334-9513
Practice Address - Country:US
Practice Address - Phone:765-213-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072689A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201090850Medicaid
IN201090850Medicaid