Healthcare Provider Details

I. General information

NPI: 1730845462
Provider Name (Legal Business Name): GRIFFIN PLASTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ORCHARD LAKE RD STE 105
WEST BLOOMFIELD MI
48322-3424
US

IV. Provider business mailing address

6900 ORCHARD LAKE RD STE 105
WEST BLOOMFIELD MI
48322-3424
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-7788
  • Fax:
Mailing address:
  • Phone: 248-557-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DELOREAN GRIFFIN
Title or Position: CEO
Credential: MD
Phone: 313-520-1889