MEDICARE: IRENE S FOX MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01056008A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000331612	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1326091315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE S FOX MD

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1095 BROAD RIPPLE AVE
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2034
Country	:	US
Telephone Number	:	317-621-3680
Fax Number	:	317-621-3689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/27/2023

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Directions to “ IRENE S FOX MD” Practice Location

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