Provider Demographics
NPI:1013976596
Name:FOX, PHILIP S (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
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 1:1403 60TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7065
Mailing Address - Country:US
Mailing Address - Phone:616-719-4488
Mailing Address - Fax:616-719-4480
Practice Address - Street 1:1403 60TH ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-7065
Practice Address - Country:US
Practice Address - Phone:616-719-4488
Practice Address - Fax:616-719-4480
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010532142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI260D110830OtherBCBS
MI260D110830OtherBCBS
MI0N20450016Medicare ID - Type Unspecified
MIF03556Medicare UPIN