Individual
DENNIS M WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3904 W 125TH TERRACE, LEAWOOD, KS 66209-2643
(216) 255-5700
(216) 255-5701
Mailing address
23625 COMMERCE PARK, SUITE 204, BEACHWOOD, OH 44122
(216) 255-5701
(216) 255-5701
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
28051
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017159110001
—
PA
01
—
12705151
BCBS
KS
05
—
200002820A
—
KS
05
—
2345457
—
OH
01
—
300134281
RXR MEDICARE
KS
01
—
341958451004
TRICARE WEST
—
01
—
341958451010
MEDICAL MUTUAL
OH
05
—
34195845104
—
NE
05
—
6409641500
—
KY
05
—
73381701
—
AZ
05
—
806480700
—
ID
Enumeration date
11/10/2005
Last updated
12/05/2011
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