Provider Demographics
NPI:1326081936
Name:FOX, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:7340 SHADELAND STA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3979
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2135
Practice Address - Street 1:7340 SHADELAND STA
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3979
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2135
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01027045A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091490OtherANTHEM
IND94540Medicare UPIN
IN176470DMedicare PIN