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General NPI Number Information
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NPI Number | 1336501238
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Entity Type | Individual
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Provider Name | JOSEPHINE SNIDER MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/21/2019
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Provider Practice Location Address
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Address Line | 225 E CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 408-316-1544
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Fax |
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Provider Business Mailing Address
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Address Line | 750 N RUSH ST APT 1602
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City | CHICAGO
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State | IL
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Zip | 60611-2579
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.148383
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License Number State | IL
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