Provider Demographics
NPI:1043778194
Name:MUNSON HEALTHCARE CADILLAC
Entity Type:Organization
Organization Name:MUNSON HEALTHCARE CADILLAC
Other - Org Name:MCBAIN PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO SOUTH REGION
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-352-2259
Mailing Address - Street 1:3782 MOMENTUM PLACE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5337
Mailing Address - Country:US
Mailing Address - Phone:231-935-6080
Mailing Address - Fax:231-935-6081
Practice Address - Street 1:100 N ROLAND ST
Practice Address - Street 2:
Practice Address - City:MC BAIN
Practice Address - State:MI
Practice Address - Zip Code:49657-9683
Practice Address - Country:US
Practice Address - Phone:231-825-8101
Practice Address - Fax:231-825-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty