Healthcare Provider Details

I. General information

NPI: 1508947375
Provider Name (Legal Business Name): SHOE DOX, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARAGON MEDICAL BUILDING SUITE 304
ST. THOMAS VI
00802
US

IV. Provider business mailing address

PO BOX 455
BLUE ISLAND IL
60406-0455
US

V. Phone/Fax

Practice location:
  • Phone: 340-344-4160
  • Fax: 708-335-2294
Mailing address:
  • Phone: 708-288-4931
  • Fax: 708-335-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY WALTER FOX
Title or Position: CEO
Credential:
Phone: 708-288-4931