Provider Demographics
NPI:1023269271
Name:MARK A SNIDER MD PC
Entity type:Organization
Organization Name:MARK A SNIDER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:CMRS
Authorized Official - Phone:734-242-0400
Mailing Address - Street 1:905 N MACOMB ST
Mailing Address - Street 2:STE 4
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3075
Mailing Address - Country:US
Mailing Address - Phone:734-242-6161
Mailing Address - Fax:734-243-6644
Practice Address - Street 1:905 N MACOMB ST
Practice Address - Street 2:STE 4
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3075
Practice Address - Country:US
Practice Address - Phone:734-242-6161
Practice Address - Fax:734-242-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0581120OtherBLUE CROSS BLUE SHIELD
MIDP9638OtherPALMETTO GBA - RR MEDICARE
MI0581120OtherBLUE CROSS BLUE SHIELD