Provider Demographics
NPI:1386653103
Name:WILCOX, DANIEL K (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:K
Last Name:WILCOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1140 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-1048
Mailing Address - Country:US
Mailing Address - Phone:906-328-2148
Mailing Address - Fax:906-643-6509
Practice Address - Street 1:4048 CEDAR BLUFF DR
Practice Address - Street 2:SUITE 1
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8895
Practice Address - Country:US
Practice Address - Phone:231-347-5155
Practice Address - Fax:231-347-6128
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301065867207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4326997Medicaid
MI4326997Medicaid
MIH43720Medicare UPIN