Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | IL | |
N | 1223G0001X | General Practice | IL | |
N | 213EG0000X | General Practice | IL |
NPI | 1114086683 |
---|---|
Provider Name | John Stephen Fox |
First Address | Buffalo Grove, IL 60089-6804 |
Second Address | Arlington Heights, IL 60004-3908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |