Provider Demographics
NPI:1659485332
Name:LYKO, ADAM A (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:A
Last Name:LYKO
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:PO BOX 3482
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-3482
Mailing Address - Country:US
Mailing Address - Phone:208-758-0075
Mailing Address - Fax:208-758-0076
Practice Address - Street 1:1125 E POLSTON AVE STE B
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6045
Practice Address - Country:US
Practice Address - Phone:208-758-0075
Practice Address - Fax:208-758-0076
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80182207R00000X
WAMD60243932207RE0101X
IDM13023207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I36798Medicare UPIN
00A801820Medicare ID - Type Unspecified