Provider Demographics
NPI:1558444711
Name:FOX, MICHAEL L (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:FOX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:27550 JOY RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4145
Mailing Address - Country:US
Mailing Address - Phone:734-261-3290
Mailing Address - Fax:734-261-0775
Practice Address - Street 1:27550 JOY RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4145
Practice Address - Country:US
Practice Address - Phone:734-261-3290
Practice Address - Fax:734-261-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007101207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4199150Medicaid
MI4199150Medicaid
MIA75876Medicare UPIN