Healthcare Provider Details

I. General information

NPI: 1689050858
Provider Name (Legal Business Name): MUNSON HEALTHCARE GRAYLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MICHIGAN AVE
GRAYLING MI
49738-7074
US

IV. Provider business mailing address

3781 MOMENTUM PL
CHICAGO IL
60689-5337
US

V. Phone/Fax

Practice location:
  • Phone: 989-348-0550
  • Fax:
Mailing address:
  • Phone: 231-935-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 7
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