Individual
LORI ANN KOCUR-WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
134 REBEL RD, KING OF PRUSSIA, PA 19406-2383
(215) 696-6078
Mailing address
134 REBEL RD, KING OF PRUSSIA, PA 19406-2383
(215) 696-6078
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC 003384L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0431485000
INDEPENDENCE BLUE CROSS
PA
01
—
608729
HIGHMARK BLUE CROSS BLUE SHIELD
PA
Enumeration date
06/08/2006
Last updated
06/09/2014
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