Healthcare Provider Details

I. General information

NPI: 1982968665
Provider Name (Legal Business Name): ADAM PAUL KIPP MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E RIVERSIDE DR STE 224
EAGLE ID
83616-6865
US

IV. Provider business mailing address

PO BOX 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-6000
  • Fax: 208-302-6055
Mailing address:
  • Phone: 208-367-5170
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-12218
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: