Provider Demographics
NPI:1629024120
Name:OPBROEK, ADAM JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JOHN
Last Name:OPBROEK
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 1:115 N 7TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2710
Mailing Address - Country:US
Mailing Address - Phone:605-645-0100
Mailing Address - Fax:605-717-1009
Practice Address - Street 1:115 N 7TH ST
Practice Address - Street 2:STE 6
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2700
Practice Address - Country:US
Practice Address - Phone:605-645-0100
Practice Address - Fax:605-717-1009
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD97892084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2011192Medicaid
SDS110422Medicare PIN
SDS110422Medicare PIN
CAGC769AMedicare PIN