MEDICARE: DR. TIMOTHY BRIAN SNYDER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	TS0001939	MI

General Provider Information

NPI Number	:	1245238153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY BRIAN SNYDER DPM

Provider Business Mailing Address
First Line	:	25656 SCHOENHERR RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-1447
Country	:	US
Telephone Number	:	586-779-4820
Fax Number	:	586-779-9535

Provider Business Practice Location Address
First Line	:	25656 SCHOENHERR RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-1447
Country	:	US
Telephone Number	:	586-779-4820
Fax Number	:	586-779-9535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	09/27/2011

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