Provider Demographics
NPI:1558904144
Name:FOX, TINIKI (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:TINIKI
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 MANNING AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-1076
Mailing Address - Country:US
Mailing Address - Phone:847-641-7100
Mailing Address - Fax:
Practice Address - Street 1:1361 MANNING AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-1076
Practice Address - Country:US
Practice Address - Phone:847-641-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2021-09-14
Deactivation Date:2020-03-22
Deactivation Code:
Reactivation Date:2021-09-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy