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NPI Code Detail

MEDICARE: KADARIUS CORRELL GRIFFIN

MEDICARE: KADARIUS CORRELL GRIFFIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1U0938874903OTHERILCIGNA

General Provider Information

NPI Number : 1134787997
Entity Type Code : Individual
Provider Name (Legal Business Name) : KADARIUS CORRELL GRIFFIN
Provider Business Mailing Address
First Line : PO BOX 3477
Second Line :
City : OAK PARK
State : IL
Zip : 60303-3477
Country : US
Telephone Number : 708-548-9308
Fax Number :
Provider Business Practice Location Address
First Line : 11411 N LINCOLN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-7647
Country : US
Telephone Number : 708-548-9308
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2019
Last Update Date : 06/05/2019

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Directions to “ KADARIUS CORRELL GRIFFIN ” Practice Location

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