=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932131349
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID MICHIGAN ANESTHESIOLOGY GROUP, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4005 ORCHARD DR
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48670-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-839-3606
-----------------------------------------------------
Fax | 989-839-1509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4005 ORCHARD DR
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48670-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-839-3606
-----------------------------------------------------
Fax | 989-839-1509
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT L SNYDER
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 989-839-3609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------