Healthcare Provider Details

I. General information

NPI: 1740372663
Provider Name (Legal Business Name): MUNSON HEALTHCARE CADILLAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOBART ST
CADILLAC MI
49601-2331
US

IV. Provider business mailing address

400 HOBART ST
CADILLAC MI
49601-2331
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-7374
  • Fax: 231-876-7894
Mailing address:
  • Phone: 231-876-7374
  • Fax: 231-876-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010627
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN LARAIA
Title or Position: VP, ANCILLARY SERVICES
Credential:
Phone: 231-392-8410