Provider Demographics
NPI:1275583148
Name:FOX, ANDREW MICKLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MICKLE
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 S PUUNENE AVE # 102
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2192
Mailing Address - Country:US
Mailing Address - Phone:808-871-8611
Mailing Address - Fax:808-893-0211
Practice Address - Street 1:53 S PUUNENE AVE # 102
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2192
Practice Address - Country:US
Practice Address - Phone:808-871-8611
Practice Address - Fax:808-893-0211
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10042208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI24660800Medicaid
HI24660800Medicaid
BF0307428OtherFEDERAL DEA