Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D12808 | MN |
Y | 213EG0000X | General Practice | D12808 | MN |
NPI | 1003136003 |
---|---|
Provider Name | Steven T Maroney |
First Address | Edina, MN 55435-1805 |
Second Address | Edina, MN 55436-2337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 02/06/2010 |