Basic Information
| Provider Information | |||||||||
| NPI: | 1194718296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNYDER | ||||||||
| FirstName: | KAMILIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 PIERCE | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486451740 | ||||||||
| FaxNumber: | 2486455304 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 PIERCE ST | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480091751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486451740 | ||||||||
| FaxNumber: | 2486455304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | KS038090 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 5201266 | 01 | MI | AETNA | OTHER | C5892 | 01 | MI | MCARE | OTHER | D91401 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | P88821 | 01 | MI | BLUE CARE NETWORK | OTHER | 4262174 | 05 | MI | MEDICAID |