Individual
DR. TIMOTHY R WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
560 W MITCHELL ST, STE 210, PETOSKEY, MI 49770-2275
(231) 487-2340
(231) 487-2115
Mailing address
560 W MITCHELL ST, STE 210, PETOSKEY, MI 49770-2275
(231) 487-2340
(231) 487-2115
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301049257
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160B41011
BCBS MI
MI
01
—
383445481
TAX ID
MI
05
—
4640277
—
MI
Enumeration date
03/10/2006
Last updated
10/28/2010
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