Provider Demographics
NPI:1467584565
Name:MICHAEL L. GRIFFIN, MD, INC
Entity Type:Organization
Organization Name:MICHAEL L. GRIFFIN, MD, INC
Other - Org Name:CHILDREN'S CARDIOLOGY OF THE BAY AREA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-558-8280
Mailing Address - Street 1:2051 PIONEER CT
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1719
Mailing Address - Country:US
Mailing Address - Phone:650-558-8280
Mailing Address - Fax:650-558-8281
Practice Address - Street 1:2051 PIONEER CT
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1719
Practice Address - Country:US
Practice Address - Phone:650-558-8280
Practice Address - Fax:650-558-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG630512080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G630510OtherMEDICAL
CA1073543914OtherINDIVIDUAL NPI
CAA53719Medicare UPIN