Healthcare Provider Details

I. General information

NPI: 1033907803
Provider Name (Legal Business Name): JOHN LEONARD FOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7886 CANYON RIDGE CT SE
ADA MI
49301-8315
US

IV. Provider business mailing address

7886 CANYON RIDGE CT SE
ADA MI
49301-8315
US

V. Phone/Fax

Practice location:
  • Phone: 616-460-0241
  • Fax:
Mailing address:
  • Phone: 616-460-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301077318
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: