Provider Demographics
NPI:1891739397
Name:FOX, TARA S (DPM)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:S
Last Name:FOX
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3719
Mailing Address - Country:US
Mailing Address - Phone:847-298-0819
Mailing Address - Fax:847-504-5015
Practice Address - Street 1:9401 MEADOW LN
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3719
Practice Address - Country:US
Practice Address - Phone:847-298-0819
Practice Address - Fax:847-504-5015
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43243300Medicaid
ILK32064Medicare PIN
V10279Medicare UPIN
ILK32066Medicare PIN
ILK32063Medicare PIN
ILK32065Medicare PIN
P00373406Medicare PIN