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General NPI Number Information
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NPI Number | 1417033143
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Entity Type | Organization
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Legal Business Name | MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 14700 LAKE SHORE DRIVE
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City | CHARLEVOIX
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State | MI
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Zip | 49720-1931
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Country | US
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Telephone | 231-547-4024
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Fax | 231-547-8088
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Provider Business Mailing Address
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Address Line | 14700 LAKE SHORE DRIVE
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City | CHARLEVOIX
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State | MI
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Zip | 49720-1931
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Country | US
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Telephone | 231-547-4024
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Fax | 231-547-8088
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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