Provider Demographics
NPI:1093989816
Name:SANDRA K. FOX, DPM
Entity Type:Organization
Organization Name:SANDRA K. FOX, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.P.M.
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:937-376-2002
Mailing Address - Street 1:1063 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1928
Mailing Address - Country:US
Mailing Address - Phone:937-376-2002
Mailing Address - Fax:937-376-4042
Practice Address - Street 1:1063 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1928
Practice Address - Country:US
Practice Address - Phone:937-376-2002
Practice Address - Fax:937-376-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002599F213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0809996Medicaid
OH4871190001Medicare NSC