Provider Demographics
NPI:1821328980
Name:MAPLEWOOD PODIATRY
Entity Type:Organization
Organization Name:MAPLEWOOD PODIATRY
Other - Org Name:
Other - Org Type:
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:
Authorized Official - Credentials:DPM
Authorized Official - Phone:651-770-3891
Mailing Address - Street 1:2520 WHITE BEAR AVE N
Mailing Address - Street 2:SUITE A
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5136
Mailing Address - Country:US
Mailing Address - Phone:651-770-3891
Mailing Address - Fax:651-748-3117
Practice Address - Street 1:257 W SAINT GEORGE AVE
Practice Address - Street 2:
Practice Address - City:GRANTSBURG
Practice Address - State:WI
Practice Address - Zip Code:54840-7827
Practice Address - Country:US
Practice Address - Phone:715-468-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty