Basic Information
| Provider Information | |||||||||
| NPI: | 1114024486 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CC GRIGGS HOLDING, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18455 JAMES COUZENS FWY | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482352506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133417870 | ||||||||
| FaxNumber: | 3133417950 | ||||||||
| Practice Location | |||||||||
| Address1: | 18455 JAMES COUZENS FWY | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482352506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133417870 | ||||||||
| FaxNumber: | 3133417950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 06/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | GRIGGS | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | CLAUDINE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3133417870 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4030161868 | MI | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 4030161868 | MI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.