Basic Information
| Provider Information | |||||||||
| NPI: | 1932199965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFITHS | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6227 FRANKFORT HWY | ||||||||
| Address2: | |||||||||
| City: | BENZONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496168632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318829661 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8225 LAKE ST | ||||||||
| Address2: | |||||||||
| City: | BEAR LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496149612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318643314 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 12/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39606 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 4301091466 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.