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Physician Information

Update Your Information

Keep your WCMI physician profile current by updating your information.

Last name *

First name *

Speciality (if any)

I am a family physician

Email address *

Contact phone number *

Fax number for reports *

Billing number *

Clinic or hospital affiliations

Add every location where you practice.

A separate record will be created for each location you add. This helps us match requisitions to the correct referral source and fax reports to the right place.

Location 1

Clinic or hospital name *

Address or city *

Fax number for reports *

I confirm that the information above is current and complete. I authorize WCMI to update its physician records and remove outdated practice locations or contact information not listed above.