Healthcare Provider Details

I. General information

NPI: 1922152933
Provider Name (Legal Business Name): MARTIN S FOX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 KRESGE WAY SUITE 320
LOUISVILLE KY
40207-4640
US

IV. Provider business mailing address

4001 KRESGE WAY SUITE 320
LOUISVILLE KY
40207-4640
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-5850
  • Fax: 502-895-1210
Mailing address:
  • Phone: 502-895-5850
  • Fax: 502-895-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RUTH S FOX
Title or Position: ADMINISTRATOR
Credential:
Phone: 502-895-5850