Healthcare Provider Details

I. General information

NPI: 1336539063
Provider Name (Legal Business Name): MUNSON HEALTHCARE CADILLAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ROLAND ST
MC BAIN MI
49657-9683
US

IV. Provider business mailing address

3782 MOMENTUM PL
CHICAGO IL
60689-5337
US

V. Phone/Fax

Practice location:
  • Phone: 231-825-8101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BONNIE KRUSZKA
Title or Position: COO MUNSON PHYSICIAN NETWORK
Credential:
Phone: 231-935-4995