Healthcare Provider Details

I. General information

NPI: 1417033143
Provider Name (Legal Business Name): MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 LAKE SHORE DRIVE
CHARLEVOIX MI
49720-1931
US

IV. Provider business mailing address

14700 LAKE SHORE DR
CHARLEVOIX MI
49720-1931
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-4024
  • Fax: 231-547-8088
Mailing address:
  • Phone: 231-547-4024
  • Fax: 231-547-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL FRYE
Title or Position: PRES. AMBULATORY & BUS. DEVELOPMENT
Credential: MD
Phone: 704-458-8010