Provider Demographics
NPI:1245238153
Name:SNYDER, TIMOTHY BRIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BRIAN
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25656 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1447
Mailing Address - Country:US
Mailing Address - Phone:586-779-4820
Mailing Address - Fax:586-779-9535
Practice Address - Street 1:25656 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1447
Practice Address - Country:US
Practice Address - Phone:586-779-4820
Practice Address - Fax:586-779-9535
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS0001939213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66465Medicare UPIN
0E06189008Medicare ID - Type Unspecified