Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | IL |
NPI | 1144355926 |
---|---|
Provider Name | Colleen Fox |
First Address | Oak Park, IL 60304-2209 |
Second Address | Chicago, IL 60657-5147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |