Provider Demographics
NPI:1619080439
Name:OLSCAMP, ADAM JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JAMES
Last Name:OLSCAMP
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 1:1233 N NORTHWOOD CENTER CT STE 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6190
Mailing Address - Country:US
Mailing Address - Phone:208-457-4211
Mailing Address - Fax:208-773-1473
Practice Address - Street 1:1233 N NORTHWOOD CENTER CT STE 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6190
Practice Address - Country:US
Practice Address - Phone:208-457-4211
Practice Address - Fax:208-773-1473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6956207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1619080439Medicaid
G26530Medicare UPIN