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General NPI Number Information
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NPI Number | 1154123560
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Entity Type | Individual
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Provider Name | MAXWELL ROONEY
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Gender | Male
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 3410 ILLINOIS ST
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City | GREAT LAKES
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State | IL
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Zip | 60088-3120
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Country | US
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Telephone | 847-688-2469
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Fax |
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Provider Business Mailing Address
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Address Line | 11980 36TH CIR NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-1056
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Country | US
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Telephone | 612-750-3396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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