Provider Demographics
NPI:1912556937
Name:SENIORWELL POD OF MINNESOTA, LLC
Entity Type:Organization
Organization Name:SENIORWELL POD OF MINNESOTA, LLC
Other - Org Name:SENIORWELL POD OF MINNESOTA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-882-3127
Mailing Address - Street 1:2100 E LAKE COOK RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1999
Mailing Address - Country:US
Mailing Address - Phone:844-882-3127
Mailing Address - Fax:844-246-5875
Practice Address - Street 1:100 S 5TH ST STE 1900
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-1267
Practice Address - Country:US
Practice Address - Phone:844-882-3127
Practice Address - Fax:844-246-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty