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General NPI Number Information
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NPI Number | 1578961660
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Entity Type | Organization
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Legal Business Name | MUNSON HEALTHCARE GRAYLING
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 1100 E MICHIGAN AVE
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City | GRAYLING
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State | MI
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Zip | 49738-1312
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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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Provider Business Mailing Address
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Address Line | 3781 MOMENTUM PL
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City | CHICAGO
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State | IL
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Zip | 60689-5337
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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 | 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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery 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 | 208600000X
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Taxonomy Name | Surgery 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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | MI
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