Healthcare Provider Details

I. General information

NPI: 1508492133
Provider Name (Legal Business Name): MUNSON HEALTHCARE GRAYLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W NORTH DOWN RIVER RD STE C
GRAYLING MI
49738-8024
US

IV. Provider business mailing address

1200 W NORTH DOWN RIVER RD STE C
GRAYLING MI
49738-8024
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-6455
  • Fax: 231-935-6646
Mailing address:
  • Phone: 231-935-6455
  • Fax: 231-935-6646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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