Provider Demographics
NPI:1427129659
Name:GRIFFITH, CAMERON MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:MICHAEL
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9368 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4610
Mailing Address - Country:US
Mailing Address - Phone:734-416-3900
Mailing Address - Fax:734-416-3903
Practice Address - Street 1:5757 WHITMORE LAKE
Practice Address - Street 2:SUITE 900
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1956
Practice Address - Country:US
Practice Address - Phone:810-220-5793
Practice Address - Fax:810-220-5805
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006866208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700C810410OtherBLUE CROSS BLUE SHIELD
MIMI5759Medicare PIN