Individual
DR. SEAN THOMAS WILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8100 W 78TH ST, SUITE 230, EDINA, MN 55439-2516
(952) 946-9777
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
54642
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250001056
MEDICARE PTAN
MN
Enumeration date
10/03/2006
Last updated
03/02/2021
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