Provider Demographics
NPI:1134261662
Name:FOX, WILLIAM HAYDEN (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HAYDEN
Last Name:FOX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2100
Mailing Address - Country:US
Mailing Address - Phone:269-683-1868
Mailing Address - Fax:269-683-9203
Practice Address - Street 1:201 N 17TH ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2100
Practice Address - Country:US
Practice Address - Phone:269-683-1868
Practice Address - Fax:269-683-9203
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001434213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5115003OtherBLUE CROSS BLUE SHIELD
MI4468900Medicaid
MI5115003OtherBLUE CROSS BLUE SHIELD