Provider Demographics
NPI:1528179314
Name:WILCOX, LORI L (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:L
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5700 BOTTINEAU BLVD
Mailing Address - Street 2:#210
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3183
Mailing Address - Country:US
Mailing Address - Phone:763-587-7000
Mailing Address - Fax:763-587-7015
Practice Address - Street 1:5700 BOTTINEAU BLVD
Practice Address - Street 2:#210
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3183
Practice Address - Country:US
Practice Address - Phone:763-587-7000
Practice Address - Fax:763-587-7015
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN30782207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN426785100Medicaid
MN426785100Medicaid
MN160000309Medicare ID - Type Unspecified