MEDICARE: GLENN CHARLES GRIFFITHS 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	207Q00000X	Family Medicine Physician	39606	NC
2	207Q00000X	Family Medicine Physician	4301091466	MI

General Provider Information

NPI Number	:	1932199965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN CHARLES GRIFFITHS M.D.

Provider Business Mailing Address
First Line	:	6227 FRANKFORT HWY
Second Line	:
City	:	BENZONIA
State	:	MI
Zip	:	49616-8632
Country	:	US
Telephone Number	:	231-882-9661
Fax Number	:

Provider Business Practice Location Address
First Line	:	8225 LAKE ST
Second Line	:
City	:	BEAR LAKE
State	:	MI
Zip	:	49614-9612
Country	:	US
Telephone Number	:	231-864-3314
Fax Number	:

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	12/18/2020

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