MEDICARE: DIANNA L 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	208000000X	Pediatrics Physician	01056313A	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	000000238402	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1922064930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNA L FOX MD

Provider Business Mailing Address
First Line	:	8910 PURDUE RD
Second Line	:	STE.500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 WISHARD BLVD
Second Line	:	2ND FL
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2872
Country	:	US
Telephone Number	:	317-692-2363
Fax Number	:	317-656-3971

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/22/2011

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Directions to “ DIANNA L FOX MD” Practice Location

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