Provider Demographics
NPI:1326091315
Name:FOX, IRENE S (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:S
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1095 BROAD RIPPLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2034
Practice Address - Country:US
Practice Address - Phone:317-621-3680
Practice Address - Fax:317-621-3689
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01056008A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200376320Medicaid
IN000000331612OtherANTHEM
INP00258681Medicare PIN
IN200376320Medicaid
IN214960BMedicare PIN
INM400019366Medicare PIN
INM400046023Medicare PIN