Provider Demographics
NPI:1760437263
Name:GANTNER-OVERMYER, CATHIE (MD)
Entity Type:Individual
Prefix:
First Name:CATHIE
Middle Name:
Last Name:GANTNER-OVERMYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S MAPLE AVE
Mailing Address - Street 2:3E
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1022
Mailing Address - Country:US
Mailing Address - Phone:708-660-5900
Mailing Address - Fax:708-660-2210
Practice Address - Street 1:520 S MAPLE AVE
Practice Address - Street 2:3E
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1022
Practice Address - Country:US
Practice Address - Phone:708-660-5900
Practice Address - Fax:708-660-2210
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF25081Medicare UPIN