Provider Demographics
NPI:1437267820
Name:SNEIDER, KEVIN L (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:SNEIDER
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 1:611 FULTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452
Mailing Address - Country:US
Mailing Address - Phone:419-734-3338
Mailing Address - Fax:419-734-2195
Practice Address - Street 1:611 FULTON STREET
Practice Address - Street 2:SUITE B
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2008
Practice Address - Country:US
Practice Address - Phone:419-734-3338
Practice Address - Fax:419-734-2195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002578213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0609756Medicaid
OH137445OtherANTHEM BCBS OF OHIO
OHU16723Medicare UPIN
OHSN0649488Medicare ID - Type Unspecified
OH137445OtherANTHEM BCBS OF OHIO