Provider Demographics
NPI:1730564105
Name:FOX PEDIATRICS,PLC
Entity type:Organization
Organization Name:FOX PEDIATRICS,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANZA
Authorized Official - Middle Name:I
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-400-4369
Mailing Address - Street 1:1205 S MISSION ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3939
Mailing Address - Country:US
Mailing Address - Phone:989-400-4369
Mailing Address - Fax:989-400-4769
Practice Address - Street 1:1205 S MISSION ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3939
Practice Address - Country:US
Practice Address - Phone:989-400-4369
Practice Address - Fax:989-400-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087542208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty