Basic Information
| Provider Information | |||||||||
| NPI: | 1861504631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 MCCORMICK BLVD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476730718 | ||||||||
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| Practice Location | |||||||||
| Address1: | BELHAVEN HEALTHCARE & RETIREMENT | ||||||||
| Address2: | 11401 S OAKLEY AVE | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606434196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732336311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 45932 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 34419000 | 05 | WI | MEDICAID |