Healthcare Provider Details

I. General information

NPI: 1629024120
Provider Name (Legal Business Name): ADAM JOHN OPBROEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/01/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N 7TH ST STE 6
SPEARFISH SD
57783-2700
US

IV. Provider business mailing address

115 N 7TH ST STE 6
SPEARFISH SD
57783-2710
US

V. Phone/Fax

Practice location:
  • Phone: 605-645-0100
  • Fax: 605-717-1009
Mailing address:
  • Phone: 605-645-0100
  • Fax: 605-717-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9789
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9789
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: