Provider Demographics
NPI:1770558462
Name:FOX, MARY C (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:FOX
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE1
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-547-1614
Mailing Address - Fax:262-547-0192
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE1
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-547-1614
Practice Address - Fax:262-547-0192
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-04-03
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Provider Licenses
StateLicense IDTaxonomies
WI37998207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34012700Medicaid
WI000868770Medicare PIN
WIH24218Medicare UPIN