Individual
MRS. SUSAN FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MMS
Contact information
Practice address
1725 W HARRISON ST STE 117, CHICAGO, IL 60612-3848
(312) 942-6296
Mailing address
1656 W FARWELL AVE APT 3F, CHICAGO, IL 60626-3623
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002353
IL
Other
Enumeration date
05/10/2007
Last updated
07/08/2007
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