Provider Demographics
NPI:1043507726
Name:SNYDER, VIVIAN SETSUKO (DO)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:SETSUKO
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:572 SHERIDAN SQ
Mailing Address - Street 2:#3
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4761
Mailing Address - Country:US
Mailing Address - Phone:530-574-1909
Mailing Address - Fax:
Practice Address - Street 1:2650 RIDGE AVENUE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-570-2730
Practice Address - Fax:847-570-1938
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125060106207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology