Healthcare Provider Details

I. General information

NPI: 1336501238
Provider Name (Legal Business Name): JOSEPHINE SNIDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

750 N RUSH ST APT 1602
CHICAGO IL
60611-2579
US

V. Phone/Fax

Practice location:
  • Phone: 408-316-1544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.148383
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: