Provider Demographics
NPI:1235106238
Name:FOX, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 BALTIMORE DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7962
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-808-6444
Practice Address - Fax:570-808-5040
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043021L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001246097Medicaid
E87961Medicare UPIN