Provider Demographics
NPI:1942462353
Name:FOX, KATHERINE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARIE
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:SZCZEPANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1300 S CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2386
Mailing Address - Country:US
Mailing Address - Phone:608-849-4315
Mailing Address - Fax:608-850-1606
Practice Address - Street 1:1300 S CENTURY AVE
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2386
Practice Address - Country:US
Practice Address - Phone:608-849-4315
Practice Address - Fax:608-850-1606
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.127122207Q00000X, 207QB0002X, 207QS0010X
WI71735207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1942462353Medicaid
821050OtherGROUP MEDICARE PTAN
ILIL1854002Medicare UPIN