Healthcare Provider Details

I. General information

NPI: 1578582391
Provider Name (Legal Business Name): KEVIN T SNYDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 FLUSHING RD
FLUSHING MI
48433-2229
US

IV. Provider business mailing address

1434 FLUSHING RD
FLUSHING MI
48433-2229
US

V. Phone/Fax

Practice location:
  • Phone: 810-659-3196
  • Fax: 810-659-5603
Mailing address:
  • Phone: 810-659-3196
  • Fax: 810-659-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101009275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: