Healthcare Provider Details

I. General information

NPI: 1013440890
Provider Name (Legal Business Name): ADAM SNOAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NAVARRE PL STE 4460
SOUTH BEND IN
46601-1168
US

IV. Provider business mailing address

3245 HEALTH DRIVE SUITE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-235-1010
  • Fax: 574-232-2064
Mailing address:
  • Phone: 574-647-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number510031001749
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number510031001749
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number01090526A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: