Provider Demographics
NPI:1578725180
Name:GRIFFIN, BETH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:KONICEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10625 W NORTH AVE
Mailing Address - Street 2:102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2315
Mailing Address - Country:US
Mailing Address - Phone:262-880-8107
Mailing Address - Fax:
Practice Address - Street 1:3201 S 16TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4537
Practice Address - Country:US
Practice Address - Phone:414-647-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51426020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine