Provider Demographics
NPI:1073849428
Name:MIDLAND PODIATRY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MIDLAND PODIATRY ASSOCIATES PLLC
Other - Org Name:DAVID W. SNIDER, DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-631-8200
Mailing Address - Street 1:4911 HEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-1930
Mailing Address - Country:US
Mailing Address - Phone:989-631-8200
Mailing Address - Fax:989-631-5901
Practice Address - Street 1:4911 HEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-1930
Practice Address - Country:US
Practice Address - Phone:989-631-8200
Practice Address - Fax:989-631-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS001126213E00000X
MIJS001702213E00000X
MITL001607213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty