MEDICARE: FOX PEDIATRICS,PLC

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	208000000X	Pediatrics Physician	4301087542	MI

General Provider Information

NPI Number	:	1730564105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX PEDIATRICS,PLC

Provider Business Mailing Address
First Line	:	1205 S MISSION ST
Second Line	:	SUITE 4
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-3939
Country	:	US
Telephone Number	:	989-400-4369
Fax Number	:	989-400-4769

Provider Business Practice Location Address
First Line	:	1205 S MISSION ST
Second Line	:	SUITE 4
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-3939
Country	:	US
Telephone Number	:	989-400-4369
Fax Number	:	989-400-4769

Authorized Official
Title or Position	:	OWNER
Name	:	CONSTANZA I FOX
Credential	:	MD
Telephone Number	:	989-400-4369

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	07/27/2015

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