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General NPI Number Information
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NPI Number | 1437329992
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Entity Type | Organization
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Legal Business Name | MICHIANA ORTHOPAEDICS AND SPORTS MEDICINE, INC.
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 600 S LAKEVIEW AVE SUITE 105
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City | STURGIS
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State | MI
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Zip | 49091-2371
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Country | US
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Telephone | 269-651-9470
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Fax | 269-651-3771
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Provider Business Mailing Address
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Address Line | 600 S LAKEVIEW AVE SUITE 105
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City | STURGIS
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State | MI
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Zip | 49091-2371
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Country | US
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Telephone | 269-651-9470
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Fax | 269-651-3771
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD E GRIFFIN JR.
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Credential | M.D.
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Telephone | 269-651-9470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4301077154
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License Number State | MI
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