Provider Demographics
NPI:1235788639
Name:MUNSON HEALTHCARE GRAYLING
Entity type:Organization
Organization Name:MUNSON HEALTHCARE GRAYLING
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 1:1321 S MOUNT TOM RD
Mailing Address - Street 2:
Mailing Address - City:MIO
Mailing Address - State:MI
Mailing Address - Zip Code:48647-9518
Mailing Address - Country:US
Mailing Address - Phone:989-275-1200
Mailing Address - Fax:989-275-1210
Practice Address - Street 1:1321 S MOUNT TOM RD
Practice Address - Street 2:
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-9518
Practice Address - Country:US
Practice Address - Phone:989-275-1200
Practice Address - Fax:989-275-1210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON HEALTHCARE GRAYLING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-09
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty