Provider Demographics
NPI:1477575769
Name:GRIFFITH, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:3920 ST FRANCIS WAY STE 220
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4922
Practice Address - Country:US
Practice Address - Phone:765-502-4110
Practice Address - Fax:765-428-5951
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01043187208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200001030Medicaid
IN220170EMedicare PIN
INP00176883Medicare PIN
INB10092Medicare UPIN
IN200001030Medicaid