MEDICARE: DR. MARIJO 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	207V00000X	Obstetrics & Gynecology Physician	MS0479817	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	730887	OTHER		PHP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1603903151	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1881689123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIJO SNYDER M.D.

Provider Business Mailing Address
First Line	:	601 JOHN ST
Second Line	:	SUITE M318
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5341
Country	:	US
Telephone Number	:	269-345-6197
Fax Number	:	269-345-9734

Provider Business Practice Location Address
First Line	:	601 JOHN ST
Second Line	:	SUITE M318
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5341
Country	:	US
Telephone Number	:	269-345-6197
Fax Number	:	269-345-9734

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	01/07/2008

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