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General NPI Number Information
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NPI Number | 1407400369
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Entity Type | Organization
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Legal Business Name | MUNSON HEALTHCARE CADILLAC
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 400 HOBART ST
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City | CADILLAC
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State | MI
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Zip | 49601-2331
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Country | US
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Telephone | 231-935-6600
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Fax | 231-935-9300
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Provider Business Mailing Address
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Address Line | 1105 SIXTH ST C/O PAYER ENROLLMENT
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City | TRAVERSE CITY
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State | MI
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Zip | 49684
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Country | US
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Telephone | 231-392-0388
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Fax |
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Authorized Official
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Title or Position | COO MUNSON PHYSICIAN NETWORK
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Name | BONNIE KRUSZKA
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Credential |
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Telephone | 231-935-4995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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