Provider Demographics
NPI:1245321322
Name:GRIFFIN, ANGELA C (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:C
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6204
Practice Address - Street 1:1600 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2394
Practice Address - Country:US
Practice Address - Phone:517-381-6870
Practice Address - Fax:517-381-6871
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077613207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4309154Medicaid
MI4457738Medicaid
MI1603306482OtherBCBS INDIVIDUAL PIN
MI4309163Medicaid
MI200000002045OtherPHP PIN #
MI1603306482OtherBCBS INDIVIDUAL PIN
MI4309163Medicaid
MIM98160009Medicare PIN