Provider Demographics
NPI:1912193889
Name:A GLENN SNYDER MD MPH PLLC
Entity Type:Organization
Organization Name:A GLENN SNYDER MD MPH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUENTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-404-9545
Mailing Address - Street 1:755 W BIG BEAVER RD
Mailing Address - Street 2:STE 231B
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4900
Mailing Address - Country:US
Mailing Address - Phone:248-404-9545
Mailing Address - Fax:248-362-6157
Practice Address - Street 1:755 W BIG BEAVER RD
Practice Address - Street 2:STE 231B
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4900
Practice Address - Country:US
Practice Address - Phone:248-404-9545
Practice Address - Fax:248-362-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P16910Medicare PIN