Provider Demographics
NPI:1861456071
Name:LOCKWITZ, TODD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALAN
Last Name:LOCKWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48501-1239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4444 W BRISTOL RD STE 150
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3161
Practice Address - Country:US
Practice Address - Phone:810-230-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF52915Medicare UPIN
MIF37432324Medicare PIN
MIM40150297Medicare PIN
MI700F37550OtherBCBSM
MI700F37550OtherBCN
MIM89900036Medicare ID - Type Unspecified
MIF52915Medicare UPIN