Healthcare Provider Details

I. General information

NPI: 1588600167
Provider Name (Legal Business Name): KENNETH L FOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 S KNOXVILLE AVE STE A
SAINT MARYS OH
45885-2609
US

IV. Provider business mailing address

200 SAINT CLAIR AVE
SAINT MARYS OH
45885-2400
US

V. Phone/Fax

Practice location:
  • Phone: 419-394-9959
  • Fax: 419-394-0255
Mailing address:
  • Phone: 419-300-1129
  • Fax: 419-394-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35077708
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.077708
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: