MEDICARE: DR. MICHELE L. MIETUS-SNYDER M.D.

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	208000000X	Pediatrics Physician	G73564	CA
2	2080P0202X	Pediatric Cardiology Physician	G73564	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619077237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE L. MIETUS-SNYDER M.D.

Provider Business Mailing Address
First Line	:	1635 DIVISADERO ST
Second Line	:	SUITE 625, BOX 1821
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 KORET WAY # N-631
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2218
Country	:	US
Telephone Number	:	415-476-1313
Fax Number	:	415-476-8899

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	07/24/2008

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Directions to “ DR. MICHELE L. MIETUS-SNYDER M.D.” Practice Location

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