Provider Demographics
NPI:1770577314
Name:GRIFFIN, MARIE L (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:L
Other - Last Name:GRIFFIN-KORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4061 INDIAN CREEK PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207
Mailing Address - Country:US
Mailing Address - Phone:913-323-4747
Mailing Address - Fax:913-323-4748
Practice Address - Street 1:4061 INDIAN CREEK PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207
Practice Address - Country:US
Practice Address - Phone:913-323-4747
Practice Address - Fax:913-323-4748
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0425011207RE0101X
MO105375207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE20780Medicare UPIN
E20780Medicare UPIN
MOB945293Medicare ID - Type Unspecified