Provider Demographics
NPI:1326028051
Name:COX, EDWARD O (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:O
Last Name:COX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 BARCLAY AVE NE
Practice Address - Street 2:#300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2527
Practice Address - Country:US
Practice Address - Phone:616-391-8810
Practice Address - Fax:616-391-8897
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301039082208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4339082Medicaid
MI2669900Medicaid
MI2669900Medicaid