Healthcare Provider Details

I. General information

NPI: 1679675342
Provider Name (Legal Business Name): DIRK W SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1096 S BELSAY RD STE F
BURTON MI
48509-1948
US

IV. Provider business mailing address

3495 S CENTER RD
BURTON MI
48519-1455
US

V. Phone/Fax

Practice location:
  • Phone: 810-742-9170
  • Fax: 810-742-7150
Mailing address:
  • Phone: 810-424-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301068545
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: