Healthcare Provider Details

I. General information

NPI: 1316108434
Provider Name (Legal Business Name): MICHAEL C SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 GREENSIDE DR
SPRINGFIELD IL
62704-3245
US

IV. Provider business mailing address

2201 GREENSIDE DR
SPRINGFIELD IL
62704-3245
US

V. Phone/Fax

Practice location:
  • Phone: 217-787-0168
  • Fax:
Mailing address:
  • Phone: 217-787-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-043479
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: