Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301065948 | MI |
N | 207PE0004X | Emergency Medical Services | 4301065948 | MI |
NPI | 1003877424 |
---|---|
Provider Name | Dr. Matthew J Griffin |
First Address | Livonia, MI 48154-1517 |
Second Address | Detroit, MI 48235-2624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103482084 | (05) | MI |
103482093 | (05) | MI |
G74772 | (02) | MI |
MG065948 | BC/BS OF MI (01) | MI |