Healthcare Provider Details

I. General information

NPI: 1427042902
Provider Name (Legal Business Name): MARY B. SNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 W RAWSON AVE SUITE 213
FRANKLIN WI
53132-8278
US

IV. Provider business mailing address

PO BOX 689711
MILWAUKEE WI
53268-9711
US

V. Phone/Fax

Practice location:
  • Phone: 414-525-1506
  • Fax:
Mailing address:
  • Phone: 414-456-3100
  • Fax: 414-456-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27902
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: