Active NPI
David J Wilcox, DO
- Family Medicine Physician
- Traverse City, MI
National Provider Identifier
1073512539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101006338
- Practice address
- 906 Business Park Dr
Traverse City, MI 49686-8683 - Phone
- (800) 968-6866
- NPI assigned
- Jul 18, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101006338 | MI | Primary |
Addresses
Primary practice location
906 Business Park Dr
Traverse City, MI 49686-8683
Mailing address
PO Box 3318
Grand Rapids, MI 49501-3318
Phone (800) 968-6866
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DW006338 | Other | BLUE CROSS BLUE SHIELD | |
| 4602730 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101006338 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203552000000",
"number": "1073512539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3318",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495013318",
"telephone_number": "800-968-6866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "906 BUSINESS PARK DR",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496868683",
"telephone_number": "800-968-6866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILCOX",
"first_name": "DAVID",
"middle_name": "J",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-18",
"last_updated": "2008-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101006338",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "DW006338",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4602730",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.