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General NPI Number Information
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NPI Number | 1386198414
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Entity Type | Individual
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Provider Name | GRIFFIN NEWELL HADDAD ATC
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Gender | Male
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 1200 S STATE ST
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City | ANN ARBOR
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State | MI
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Zip | 48109-2203
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Country | US
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Telephone | 734-764-0331
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Fax |
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Provider Business Mailing Address
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Address Line | 618 S MAIN ST APT. 303
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City | ANN ARBOR
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State | MI
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Zip | 48104-2997
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001685
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License Number State | MI
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