Provider Demographics
NPI:1295458792
Name:SNIPES, SIDDIQUI
Entity type:Individual
Prefix:
First Name:SIDDIQUI
Middle Name:
Last Name:SNIPES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20844 WOODWARD ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3583
Mailing Address - Country:US
Mailing Address - Phone:313-850-2723
Mailing Address - Fax:
Practice Address - Street 1:20844 WOODWARD ST
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3583
Practice Address - Country:US
Practice Address - Phone:313-850-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12345Medicaid