Individual
KADARIUS CORRELL GRIFFIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11411 N LINCOLN BLVD, OKLAHOMA CITY, OK 73114-7647
(708) 548-9308
Mailing address
PO BOX 3477, OAK PARK, IL 60303-3477
(708) 548-9308
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U0938874903
CIGNA
IL
Enumeration date
06/05/2019
Last updated
06/05/2019
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