Provider Demographics
NPI:1598095093
Name:MAPLEWOOD PODIATRY, LLC
Entity Type:Organization
Organization Name:MAPLEWOOD PODIATRY, LLC
Other - Org Name:FOOT CARE CLNIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:651-439-5278
Mailing Address - Street 1:2520 WHITE BEAR AVE N
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5136
Mailing Address - Country:US
Mailing Address - Phone:651-439-5278
Mailing Address - Fax:
Practice Address - Street 1:1940 GREELEY ST S
Practice Address - Street 2:SUITE 122
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5097
Practice Address - Country:US
Practice Address - Phone:651-439-5278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherEIN
MNC02520Medicare PIN
MN=========OtherEIN