Healthcare Provider Details

I. General information

NPI: 1548652860
Provider Name (Legal Business Name): JUSTIN DONALD GRIFKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MIDLAND RD STE A
AUBURN MI
48611-9780
US

IV. Provider business mailing address

1111 S EUCLID AVE STE A
BAY CITY MI
48706-3302
US

V. Phone/Fax

Practice location:
  • Phone: 989-439-1235
  • Fax: 989-266-3269
Mailing address:
  • Phone: 989-928-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704265305
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: