Healthcare Provider Details

I. General information

NPI: 1710383351
Provider Name (Legal Business Name): MUNSON HEALTHCARE GRAYLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 LAKE ST
ROSCOMMON MI
48653-9203
US

IV. Provider business mailing address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2349
US

V. Phone/Fax

Practice location:
  • Phone: 989-275-1200
  • Fax:
Mailing address:
  • Phone: 231-935-5000
  • 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