Provider Demographics
NPI:1710428115
Name:SENIOR PODIATRY, PLLC
Entity Type:Organization
Organization Name:SENIOR PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-972-0274
Mailing Address - Street 1:2232 S MAIN ST
Mailing Address - Street 2:STE 405
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6938
Mailing Address - Country:US
Mailing Address - Phone:734-972-0274
Mailing Address - Fax:
Practice Address - Street 1:2232 S MAIN ST
Practice Address - Street 2:STE 405
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6938
Practice Address - Country:US
Practice Address - Phone:734-972-0274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002205213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty