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NPI Code Detail

MEDICARE: MUNSON MEDICAL CENTER DBA MUNSON MEDICAL CENTER RADIATION ONCOLOGISTS

MEDICARE: MUNSON MEDICAL CENTER DBA MUNSON MEDICAL CENTER RADIATION ONCOLOGISTS
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
12085R0001XRadiation Oncology PhysicianL458593MI

General Provider Information

NPI Number : 1376097733
Entity Type Code : Organization
Provider Name (Legal Business Name) : MUNSON MEDICAL CENTER DBA MUNSON MEDICAL CENTER RADIATION ONCOLOGISTS
Provider Business Mailing Address
First Line : PO BOX 84868
Second Line :
City : CHICAGO
State : IL
Zip : 60689-4868
Country : US
Telephone Number : 231-392-8400
Fax Number :
Provider Business Practice Location Address
First Line : 217 S MADISON AVENUE
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2320
Country : US
Telephone Number : 231-392-8400
Fax Number : 231-935-7126
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : KATHLEEN MARIE LARAIA
Credential :
Telephone Number : 231-392-8400
Provider Enumeration Date : 08/15/2016
Last Update Date : 03/11/2026

Similar Medicare Providers

1831180140 — DR. DAVID P MICHELIN MD
Practice Location Address:
217 S MADISON STREET
TRAVERSE CITY, MI
49684-2320
Practice Phone: 231-392-8400
Practice Fax: 231-935-7888
1538131396 — MS. PATRICIA DAVIS CNPF
Practice Location Address:
217 S MADISON ST
TRAVERSE CITY, MI
49684-2320
Practice Phone: 231-392-8400
Practice Fax: 231-935-7888
1477520872 — PETER C KOHLER M.D.
Practice Location Address:
217 S MADISON STREET
TRAVERSE CITY, MI
49684-2320
Practice Phone: 231-392-8400
Practice Fax: 231-935-7888
1245207695 — LISA A HUGHES D.O.
Practice Location Address:
217 S MADISON STREET
TRAVERSE CITY, MI
49684-2320
Practice Phone: 231-392-8400
Practice Fax: 231-935-7888
1366410896 — MADELYN JEAN ZEIGLER CNP
Practice Location Address:
217 S MADISON STREET
TRAVERSE CITY, MI
49684-2320
Practice Phone: 231-392-8400
Practice Fax: 231-935-7888
1467418392 — CHRISTA KIESSEL MSN, RN, CS, AOCNP
Practice Location Address:
217 S MADISON STREET
TRAVERSE CITY, MI
49684-2320
Practice Phone: 231-392-8400
Practice Fax: 231-935-7888

Directions to “MUNSON MEDICAL CENTER DBA MUNSON MEDICAL CENTER RADIATION ONCOLOGISTS ” Practice Location

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