Provider Demographics
NPI:1346418449
Name:FOX, MICHAEL JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:FOX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1403 WALTERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4633
Mailing Address - Country:US
Mailing Address - Phone:847-559-0611
Mailing Address - Fax:847-559-1385
Practice Address - Street 1:1403 WALTERS AVE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4633
Practice Address - Country:US
Practice Address - Phone:847-559-0611
Practice Address - Fax:847-559-1385
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology