Provider Demographics
NPI:1285845115
Name:ANDREW M. FOX MD LLC
Entity Type:Organization
Organization Name:ANDREW M. FOX MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICKLE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-871-8611
Mailing Address - Street 1:53 S PUUNENE AVE
Mailing Address - Street 2:SUITE 102
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
Practice Address - Street 2:SUITE 102
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10042208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD10042OtherSTATE LICENSE NUMBER
HI24660804Medicaid
HIA06523Medicare UPIN