Provider Demographics
NPI:1184998627
Name:GRIFFIN, PATRICE KATHLEEN (CDM,CMSO)
Entity type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:KATHLEEN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CDM,CMSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:B-522
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2333
Mailing Address - Country:US
Mailing Address - Phone:312-567-5593
Mailing Address - Fax:312-567-6156
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:B-522
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-5593
Practice Address - Fax:312-567-6156
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336140279284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL950150OtherMERCY HOSPITAL & MEDICAL CENTER