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General NPI Number Information
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NPI Number | 1396290185
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Entity Type | Individual
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Provider Name | KYLE GRIFFIN DMSC, PA-C, MPH, ATC
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Gender | Male
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 07/19/2025
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Provider Practice Location Address
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Address Line | 2782 S OTSEGO AVE
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City | GAYLORD
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State | MI
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Zip | 49735-9404
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Country | US
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Telephone | 989-732-7525
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Fax |
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Provider Business Mailing Address
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Address Line | 2782 S OTSEGO AVE
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City | GAYLORD
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State | MI
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Zip | 49735-9404
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Country | US
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Telephone | 899-732-7525
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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 | 0126002598
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601010798
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License Number State | MI
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