Provider Demographics
NPI:1225052400
Name:FOX, ALISON L (MD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:L
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 PARK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3736
Mailing Address - Country:US
Mailing Address - Phone:231-737-0411
Mailing Address - Fax:231-739-8502
Practice Address - Street 1:3535 PARK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3736
Practice Address - Country:US
Practice Address - Phone:231-737-0411
Practice Address - Fax:231-739-8502
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080065208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4781103Medicaid
MI350F361320OtherBCBSM