Healthcare Provider Details

I. General information

NPI: 1134341845
Provider Name (Legal Business Name): ANN MARIE SNIDER M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 EASTMAN AVE
MIDLAND MI
48640-4216
US

IV. Provider business mailing address

1714 EASTMAN AVE
MIDLAND MI
48640-4216
US

V. Phone/Fax

Practice location:
  • Phone: 989-631-5390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301098517
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35128729
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007167
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: