Provider Demographics
NPI:1689649048
Name:ESCOTE, LORICEL (MD)
Entity Type:Individual
Prefix:
First Name:LORICEL
Middle Name:
Last Name:ESCOTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORICEL
Other - Middle Name:
Other - Last Name:MANGULABNAN
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:23900 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2501
Mailing Address - Country:US
Mailing Address - Phone:248-476-6209
Mailing Address - Fax:248-476-6237
Practice Address - Street 1:23900 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2501
Practice Address - Country:US
Practice Address - Phone:248-476-6209
Practice Address - Fax:248-476-6237
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILE067373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4409220Medicaid
MI1106313771OtherBLUE CROSS BLUE SHIELD
MI1106313771OtherBLUE CROSS BLUE SHIELD
MION50710Medicare ID - Type Unspecified