Provider Demographics
NPI:1710985049
Name:GRIFFIN, MICHAEL TODD (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W PINHOOK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2464
Mailing Address - Country:US
Mailing Address - Phone:337-237-0650
Mailing Address - Fax:337-237-1086
Practice Address - Street 1:1000 W PINHOOK RD STE 201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2464
Practice Address - Country:US
Practice Address - Phone:337-237-0650
Practice Address - Fax:337-237-1086
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA10629207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q43959Medicare UPIN
LA5CA42P668Medicare ID - Type Unspecified