Provider Demographics
NPI:1487619961
Name:WYCOFF, JOHN O (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:O
Last Name:WYCOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-364-5160
Mailing Address - Fax:517-364-5165
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5160
Practice Address - Fax:517-364-5165
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3477253Medicaid
MI0853310114OtherBCBS PIN NUMBER
MIN16520001Medicare ID - Type Unspecified
MI3477253Medicaid