Provider Demographics
NPI:1932726577
Name:MUNSON HEALTHCARE CADILLAC
Entity type:Organization
Organization Name:MUNSON HEALTHCARE CADILLAC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO MUNSON PHYSICIAN NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUSZKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-4995
Mailing Address - Street 1:3782 MOMENTUM PLACE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-0001
Mailing Address - Country:US
Mailing Address - Phone:231-779-2565
Mailing Address - Fax:231-775-0744
Practice Address - Street 1:1011 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8735
Practice Address - Country:US
Practice Address - Phone:231-779-2565
Practice Address - Fax:231-775-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty