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Individual

DR. LORI A WYKOFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
415 E MADISON ST, SOUTH BEND, IN 46617
(574) 533-1234
(574) 537-2652
Mailing address
PO BOX 809, GOSHEN, IN 46527-0809
(574) 533-1234
(574) 537-2652

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01043680A
IN
2084P0800X
Psychiatry Physician
01043680A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200078780
IN
Enumeration date
10/25/2005
Last updated
04/01/2019
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