MEDICARE: MUNSON HEALTHCARE CHARLEVOIX HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1912384843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUNSON HEALTHCARE CHARLEVOIX HOSPITAL

Provider Business Mailing Address
First Line	:	14651 W UPRIGHT ST
Second Line	:
City	:	CHARLEVOIX
State	:	MI
Zip	:	49720-1266
Country	:	US
Telephone Number	:	231-547-8833
Fax Number	:	231-547-4753

Provider Business Practice Location Address
First Line	:	14651 W UPRIGHT ST
Second Line	:
City	:	CHARLEVOIX
State	:	MI
Zip	:	49720-1266
Country	:	US
Telephone Number	:	231-547-8833
Fax Number	:	231-547-4753

Authorized Official
Title or Position	:	COO MUNSON PHYSICIAN NETWORK
Name	:	BONNIE KRUSZKA
Credential	:
Telephone Number	:	231-935-4995

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	10/02/2024

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