Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125072612 | IL |
N | 111NI0900X | Internist | 125072612 | IL |
Y | 207RC0200X | Critical Care Medicine | 036155703 | IL |
N | 207RP1001X | Pulmonary Disease | 036155703 | IL |
NPI | 1063904647 |
---|---|
Provider Name | Samuel Charles Fox |
First Address | Chicago, IL 60612-3800 |
Second Address | Chicago, IL 60612-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2018 |
Last Update Date | 14/05/2021 |