Healthcare Provider Details

I. General information

NPI: 1245238153
Provider Name (Legal Business Name): TIMOTHY BRIAN SNYDER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25656 SCHOENHERR RD
WARREN MI
48089-1447
US

IV. Provider business mailing address

25656 SCHOENHERR RD
WARREN MI
48089-1447
US

V. Phone/Fax

Practice location:
  • Phone: 586-779-4820
  • Fax: 586-779-9535
Mailing address:
  • Phone: 586-779-4820
  • Fax: 586-779-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberTS0001939
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: