Provider Demographics
NPI:1578582391
Name:SNYDER, KEVIN T (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 FLUSHING RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2229
Mailing Address - Country:US
Mailing Address - Phone:810-659-3196
Mailing Address - Fax:810-659-5603
Practice Address - Street 1:1434 FLUSHING RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2229
Practice Address - Country:US
Practice Address - Phone:810-659-3196
Practice Address - Fax:810-659-5603
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700B54953OtherBLUE CROSS
MI080182055OtherMEDICARE RAILROAD PIN
MI3121126Medicaid
MI3121126Medicaid
MI080182055OtherMEDICARE RAILROAD PIN