Healthcare Provider Details

I. General information

NPI: 1831157734
Provider Name (Legal Business Name): CONSTANZA I FOX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S MISSION ST SUITE 4
MOUNT PLEASANT MI
48858-3939
US

IV. Provider business mailing address

1205 S MISSION ST SUITE 4
MOUNT PLEASANT MI
48858-3939
US

V. Phone/Fax

Practice location:
  • Phone: 989-400-4369
  • Fax: 989-400-4376
Mailing address:
  • Phone: 989-400-4369
  • Fax: 989-400-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301087542
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: