Munson Medical Center
Organization Active NPI Family Medicine Physician · Traverse City, MI
NPI 1568002004 · NPPES record last updated Oct 4, 2024
Key facts
- NPI
- 1568002004
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MUNSON MEDICAL CENTER
- Practice address
- 5085 Anna Dr Ste B&C
Traverse City, MI 49684-7475 - Phone
- (231) 935-5900
- Fax
- (231) 935-5907
- NPI assigned
- Jan 13, 2020
- Organization subpart
- No
Authorized official
- Name
- Bonnie Kruszka
- Title
- Coo Munson Physician Network
- Phone
- (231) 935-4995
Other NPIs on the same Medicare enrollment 29
Practitioners 11
-
Lora Marie Bartnick, PA-C
-
Laura Ann Christopher, NURSE PRACTITIONER
-
Richard G Faller, M.D.
-
Desiree Lynn Miller, RN FNP-BC
-
Jonathan Edward Beaulac, D.O.
-
F Matthew Smith, MD
-
Devin Nicole Rohde, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040108000904 | MI | Part B Supplier - Clinic/Group Practice | 3072426287 |
Receives reassigned benefits from 568 practitioners 29 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Manistee, MI; Traverse City, MI; Cadillac, MI; Charlevoix, MI; Cheboygan, MI; Elk Rapids, MI; Frankfort, MI; Gaylord, MI… |
National Provider Directory
Locations
5085 Anna Dr
Ste Bc
Traverse City, MI 49684
Phone (231) 935-5900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | |||
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X |
Addresses
Primary practice location
5085 Anna Dr Ste B&C
Traverse City, MI 49684-7475
Mailing address
5085 Anna Dr Ste B&C
Traverse City, MI 49684-7475
Other providers in Traverse City, MI
- Munson Medical Center
- Munson Medical Center
- Munson Medical Center
- Munson Medical Center
- Munson Medical Center
- Munson Medical Center
- Munson Medical Center
- Munson Medical Center
- Munson Medical Center
- Munson Medical Center
All providers in Traverse City, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.