Provider Demographics
NPI:1508864307
Name:WILCOX, MATTHEW D (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:WILCOX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3500 S CEDAR ST
Mailing Address - Street 2:STE 116
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-4699
Mailing Address - Country:US
Mailing Address - Phone:517-887-2511
Mailing Address - Fax:517-882-4144
Practice Address - Street 1:1140 E MICHIGAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1806
Practice Address - Country:US
Practice Address - Phone:517-364-9650
Practice Address - Fax:517-364-9605
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2019-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101014391207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4730051Medicaid
MI4730051Medicaid
MIOC36345031Medicare ID - Type Unspecified