Provider Demographics
NPI:1457300899
Name:LORICEL ESCOTE MD, PLLC
Entity Type:Organization
Organization Name:LORICEL ESCOTE MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LORICEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-539-1122
Mailing Address - Street 1:30330 W 12 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3821
Mailing Address - Country:US
Mailing Address - Phone:248-539-1122
Mailing Address - Fax:248-539-1129
Practice Address - Street 1:30330 W 12 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3821
Practice Address - Country:US
Practice Address - Phone:248-539-1122
Practice Address - Fax:248-539-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI108006OtherCARE CHOICES
MIC5349OtherMCARE
MI1106313771OtherBCBC BCN
MIG56213OtherHAP
MI4409220Medicaid
MIC5349OtherMCARE
MI108006OtherCARE CHOICES