Provider Demographics
NPI:1932239142
Name:SNYDER, MICHAEL D (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 KENNERLY RD STE 404
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-843-8222
Mailing Address - Fax:
Practice Address - Street 1:10012 KENNERLY RD STE 404
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-843-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51690-0202084N0400X
MO20150135152084N0400X, 2084N0400X
MI43011165262084N0400X
TXTM007942084N0400X
NH192622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1932239142Medicaid
NH3118701Medicaid
MN1932239142Medicaid
WI570850148Medicare PIN
MN1932239142Medicaid
MO146490009Medicare PIN
WI105074150Medicare PIN
WI032613080Medicare PIN