Healthcare Provider Details

I. General information

NPI: 1386867711
Provider Name (Legal Business Name): CAMERON WILCOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SPRING ST
MARQUETTE MI
49855-4630
US

IV. Provider business mailing address

200 W SPRING ST
MARQUETTE MI
49855-4630
US

V. Phone/Fax

Practice location:
  • Phone: 906-233-1236
  • Fax: 906-233-1235
Mailing address:
  • Phone: 906-233-1236
  • Fax: 906-233-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number4301082621
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301082621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: