Healthcare Provider Details

I. General information

NPI: 1366828527
Provider Name (Legal Business Name): MUNSON HEALTHCARE CADILLAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7985 MACKINAW TRL
CADILLAC MI
49601-8111
US

IV. Provider business mailing address

3782 MOMENTUM PL
CHICAGO IL
60689-5337
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-6200
  • Fax:
Mailing address:
  • Phone: 231-935-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: BONNIE KRUSZKA
Title or Position: COO MUNSON PHYSICIAN NETWORK
Credential:
Phone: 231-935-4995