Provider Demographics
NPI:1275792525
Name:OGRAM, ALICIA EVE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:EVE
Last Name:OGRAM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5085
Mailing Address - Fax:208-625-5731
Practice Address - Street 1:980 W IRONWOOD DR STE 1
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2617
Practice Address - Country:US
Practice Address - Phone:208-625-4333
Practice Address - Fax:208-625-4334
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2024-04-18
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Provider Licenses
StateLicense IDTaxonomies
IDM13795207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z168454Medicare PIN