Healthcare Provider Details

I. General information

NPI: 1407964034
Provider Name (Legal Business Name): JANET BURG SNIDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 01/21/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30400 TELEGRAPH RD STE 101
BINGHAM FARMS MI
48025-4538
US

IV. Provider business mailing address

30400 TELEGRAPH RD STE 101
BINGHAM FARMS MI
48025-4538
US

V. Phone/Fax

Practice location:
  • Phone: 248-642-5437
  • Fax: 248-642-5456
Mailing address:
  • Phone: 248-642-5437
  • Fax: 248-642-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301053004
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: