Michael Robert Wilcox, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20837 Issued in MN

Practice address

310 1St Ave NW
New Prague, MN 56071-1403

Phone

(952) 758-3090

Fax

(952) 758-8053

NPI assigned

Jul 18, 2006

Last updated

Mar 23, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• LTC Professionals, PLLC

  • Internal Medicine Physician
  • Bloomington, MN
  • NPI 1417251935

  Emergency Medicine

  Medicare reassignment NPD
• Allina Health System

  dba Abbott Northwestern Hospital

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1760446256
  NPD (past)
• Gary M Petrus MD PA

  • Plastic and Reconstructive Surgery Physician
  • North Little Rock, AR
  • NPI 1871666446
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300838400000",
    "number": "1801814504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 1ST AVE NW",
            "city": "NEW PRAGUE",
            "state": "MN",
            "postal_code": "560711403",
            "telephone_number": "952-758-3090",
            "fax_number": "952-758-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 1ST AVE NW",
            "city": "NEW PRAGUE",
            "state": "MN",
            "postal_code": "560711403",
            "telephone_number": "952-758-3090",
            "fax_number": "952-758-8053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCOX",
        "first_name": "MICHAEL",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2011-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "20837",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "20837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420872200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colleen Marie Turner, PT
• Keandra Tyus
• Anna Beth Viere, DO
• Leslie E. Vilensky, N.D.
• Walgreen Co (Walgreens #12972)
• George Winn, DDS
• Amy Wold
• Michael Charles Young, MD
• Koren Zurn

• Family Medicine Physician in New Prague, MN
• Providers in New Prague, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.