MEDICARE: SENIOR PODIATRY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	5901002205	MI

General Provider Information

NPI Number	:	1710428115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR PODIATRY, PLLC

Provider Business Mailing Address
First Line	:	2232 S MAIN ST
Second Line	:	STE 405
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-6938
Country	:	US
Telephone Number	:	734-972-0274
Fax Number	:

Provider Business Practice Location Address
First Line	:	2232 S MAIN ST
Second Line	:	STE 405
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-6938
Country	:	US
Telephone Number	:	734-972-0274
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. BRIAN DALEY
Credential	:	DPM
Telephone Number	:	734-972-0274

Provider Enumeration Date	:	03/17/2017
Last Update Date	:	03/17/2017

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