MEDICARE: DR. EDWARD JACKSON SNELL 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	207R00000X	Internal Medicine Physician	4301042393	MI

General Provider Information

NPI Number	:	1699757815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD JACKSON SNELL M.D.

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC 845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:	616-391-8242
Fax Number	:	616-391-8317

Provider Business Practice Location Address
First Line	:	426 MICHIGAN ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-5609
Country	:	US
Telephone Number	:	616-391-2778
Fax Number	:

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	02/22/2021

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