Provider Demographics
NPI:1942293063
Name:FOX, MICHAEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:FOX
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7550 LUCERNE DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6530
Mailing Address - Country:US
Mailing Address - Phone:440-234-8833
Mailing Address - Fax:440-234-3313
Practice Address - Street 1:6563 STAGE OAKS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2886
Practice Address - Country:US
Practice Address - Phone:901-362-5252
Practice Address - Fax:901-572-1264
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2019-09-23
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Provider Licenses
StateLicense IDTaxonomies
MS19455208600000X
TN36972208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03752259Medicaid
TN3325162Medicaid
TN3325162Medicare PIN
MS280000001Medicare PIN