Provider Demographics
NPI:1548652860
Name:GRIFKA, JUSTIN DONALD
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DONALD
Last Name:GRIFKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3309
Mailing Address - Country:US
Mailing Address - Phone:989-928-6770
Mailing Address - Fax:
Practice Address - Street 1:120 E MIDLAND RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9780
Practice Address - Country:US
Practice Address - Phone:989-439-1235
Practice Address - Fax:989-266-3269
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704265305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily