Provider Demographics
NPI:1134142722
Name:GRIFFIN, JAMES H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:745 FLETCHER DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4747
Mailing Address - Country:US
Mailing Address - Phone:847-741-0398
Mailing Address - Fax:847-741-0549
Practice Address - Street 1:745 FLETCHER DR
Practice Address - Street 2:SUITE 301
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4747
Practice Address - Country:US
Practice Address - Phone:847-741-0398
Practice Address - Fax:847-741-0549
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36088067208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36088067Medicaid
ILL58363Medicare ID - Type Unspecified
IL36088067Medicaid