Provider Demographics
NPI:1619914124
Name:FOX, MICHAEL ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROSS
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 JOHN RINGLING BLVD # 302
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-1542
Mailing Address - Country:US
Mailing Address - Phone:813-956-5435
Mailing Address - Fax:941-934-2579
Practice Address - Street 1:5602 MARQUESAS CIR STE 209
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3359
Practice Address - Country:US
Practice Address - Phone:813-956-5435
Practice Address - Fax:941-923-1579
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME794732084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016443800Medicaid
FL20636OtherEVOLUTIONS
FL20636OtherEVOLUTIONS