Provider Demographics
NPI:1427421734
Name:MICHELLE L SNYDER, DO LLC
Entity type:Organization
Organization Name:MICHELLE L SNYDER, DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-910-0544
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-0948
Mailing Address - Country:US
Mailing Address - Phone:812-910-0544
Mailing Address - Fax:844-861-8251
Practice Address - Street 1:328 N 2ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1351
Practice Address - Country:US
Practice Address - Phone:812-910-0544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001984A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty