Provider Demographics
NPI:1861504631
Name:FOX, BARRY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:MICHAEL
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 MCCORMICK BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2961
Mailing Address - Country:US
Mailing Address - Phone:847-673-0718
Mailing Address - Fax:
Practice Address - Street 1:BELHAVEN HEALTHCARE & RETIREMENT
Practice Address - Street 2:11401 S OAKLEY AVE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4196
Practice Address - Country:US
Practice Address - Phone:773-233-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45932207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34419000Medicaid
A91896Medicare UPIN