Healthcare Provider Details

I. General information

NPI: 1720955081
Provider Name (Legal Business Name): MUNSON HEALTHCARE CADILLAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SIXTH ST STE D6
TRAVERSE CITY MI
49684-2345
US

IV. Provider business mailing address

1105 SIXTH ST STE D6
TRAVERSE CITY MI
49684-2345
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-6380
  • Fax: 231-935-6920
Mailing address:
  • Phone: 231-935-6380
  • Fax: 231-935-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: BONNIE JEAN KRUSZKA
Title or Position: COO
Credential: NP
Phone: 231-935-4995