Provider Demographics
NPI:1760450217
Name:WILCOX, TIMOTHY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:WILCOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:STE 210
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2340
Mailing Address - Fax:231-487-2115
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:STE 210
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2340
Practice Address - Fax:231-487-2115
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301049257207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383445481OtherTAX ID
MI160B41011OtherBCBS MI
MI4640277Medicaid
MI4640277Medicaid
MIE81812Medicare UPIN