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General NPI Number Information
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NPI Number | 1073087292
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Entity Type | Organization
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Legal Business Name | MUNSON MEDICAL CENTER
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 1105 SIXTH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2345
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Country | US
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Telephone | 231-935-9227
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Fax | 231-935-8215
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Provider Business Mailing Address
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Address Line | 2513 MOMENTUM PL
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City | CHICAGO
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State | IL
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Zip | 60689-5325
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Country | US
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Telephone | 231-935-6080
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Fax | 231-935-6081
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Authorized Official
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Title or Position | PRESIDENT AMBULATORY CLINICS
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Name | ELLEN O SMITH
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Credential |
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Telephone | 231-935-5199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State |
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