Provider Demographics
NPI:1750662441
Name:FOX, ERIN LEE (RD)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:LEE
Last Name:FOX
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 N ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3655
Mailing Address - Country:US
Mailing Address - Phone:248-840-1607
Mailing Address - Fax:
Practice Address - Street 1:18161 W 12 MILE RD STE 2
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2662
Practice Address - Country:US
Practice Address - Phone:248-552-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01013771133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered