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General NPI Number Information
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NPI Number | 1114472370
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Entity Type | Organization
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Legal Business Name | MUNSON MEDICAL GROUP
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 4062 W ROYAL DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-8965
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Country | US
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Telephone | 231-935-0338
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Fax | 231-935-3421
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Provider Business Mailing Address
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Address Line | PO BOX 771959
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City | DETROIT
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State | MI
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Zip | 48277-1959
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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 | CFO
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Name | MARK HEPLER
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Credential |
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Telephone | 231-935-6702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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