MEDICARE: MUNSON MEDICAL CENTER

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207V00000X	Obstetrics & Gynecology Physician
2	207RX0202X	Medical Oncology Physician
3	2084P0800X	Psychiatry Physician
4	207RC0000X	Cardiovascular Disease Physician
5	208D00000X	General Practice Physician
6	208M00000X	Hospitalist Physician
7	207RP1001X	Pulmonary Disease Physician
8	207Q00000X	Family Medicine Physician
9	208000000X	Pediatrics Physician
10	208VP0000X	Pain Medicine Physician
11	207LP2900X	Pain Medicine (Anesthesiology) Physician
12	2084N0400X	Neurology Physician
13	207R00000X	Internal Medicine Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700B860180	OTHER		BLUE SHIELD
2	700B860180	OTHER		BLUE CARE NETWORK

NPI Number	:	1205864220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUNSON MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1105 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2300
Country	:	US
Telephone Number	:	231-935-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 6TH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2349
Country	:	US
Telephone Number	:	231-935-5000
Fax Number	:

Authorized Official
Title or Position	:	PRES. AMBULATORY & BUS. DEVELOPMENT
Name	:	MICHAEL FRYE
Credential	:	MD
Telephone Number	:	704-458-8010

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	04/21/2026

1105 SIXTH ST , ATTN: HOME CARE
TRAVERSE CITY, MI
49684-2349

Practice Phone: 231-935-6520
Practice Fax: 231-935-9116