MEDICARE: DR. STEPHANIE J 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	207K00000X	Allergy & Immunology Physician	104273	MN
2	208M00000X	Hospitalist Physician	2008008163	MO
3	207K00000X	Allergy & Immunology Physician	52217	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P0083991	OTHER	MN	MEDICARE RAIL ROAD

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770600884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE J FOX MD

Provider Business Mailing Address
First Line	:	3100 KENNARD ST
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-5465
Country	:	US
Telephone Number	:	651-326-1044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 KENNARD ST
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-5465
Country	:	US
Telephone Number	:	651-326-1044
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	10/24/2011

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Directions to “ DR. STEPHANIE J FOX MD” Practice Location

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