Healthcare Provider Details

I. General information

NPI: 1235058298
Provider Name (Legal Business Name): MUNSON HEALTHCARE CADILLAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 CEDAR RUN RD
TRAVERSE CITY MI
49684-9687
US

IV. Provider business mailing address

3922 CEDAR RUN RD
TRAVERSE CITY MI
49684-9687
US

V. Phone/Fax

Practice location:
  • Phone: 231-392-0430
  • Fax: 231-935-3438
Mailing address:
  • Phone: 231-392-0430
  • Fax: 231-935-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

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