MEDICARE: ERIC OMAR GRIFFIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036-098681	IL

General Provider Information

NPI Number	:	1881614469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC OMAR GRIFFIN M.D.

Provider Business Mailing Address
First Line	:	3201 S RHODES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 S RHODES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4039
Country	:	US
Telephone Number	:	312-969-1911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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