Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | IL | |
Y | 213ER0200X | Radiology | IL |
NPI | 1346418449 |
---|---|
Provider Name | Dr. Michael Jay Fox |
First Address | Northbrook, IL 60062-4633 |
Second Address | Northbrook, IL 60062-4633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 12/02/2008 |