Provider Demographics
NPI:1851626568
Name:FOX, MELANIE DIANA (DO)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:DIANA
Last Name:FOX
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-2779
Mailing Address - Fax:847-570-1938
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2779
Practice Address - Fax:847-570-1938
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2013-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.128031207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology