Healthcare Provider Details

I. General information

NPI: 1871991596
Provider Name (Legal Business Name): MUNSON HEALTHCARE CADILLAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOBART ST
CADILLAC MI
49601-2331
US

IV. Provider business mailing address

3800 MOMENTUM PL
CHICAGO IL
60689-5338
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-6080
  • Fax: 231-935-6081
Mailing address:
  • Phone: 231-935-6080
  • Fax: 231-935-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER MARINOFF
Title or Position: PRESIDENT/CEO SOUTH REGION
Credential:
Phone: 231-352-2259