Provider Demographics
NPI:1447066329
Name:MUNSON, MICHAEL MATTHEW (CPRS-R)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MATTHEW
Last Name:MUNSON
Suffix:
Gender:M
Credentials:CPRS-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 STOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2149
Mailing Address - Country:US
Mailing Address - Phone:952-288-9900
Mailing Address - Fax:
Practice Address - Street 1:14400 MARTIN DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-2031
Practice Address - Country:US
Practice Address - Phone:952-444-9576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty