Provider Demographics
NPI:1407400369
Name:MUNSON HEALTHCARE CADILLAC
Entity Type:Organization
Organization Name:MUNSON HEALTHCARE CADILLAC
Other - Org Name:SLEEP DISORDER CENTER
Other - Org Type:Other Name
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 1:1105 SIXTH ST
Mailing Address - Street 2:C/O PAYER ENROLLMENT
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-392-0388
Mailing Address - Fax:
Practice Address - Street 1:400 HOBART ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2331
Practice Address - Country:US
Practice Address - Phone:231-935-6600
Practice Address - Fax:231-935-9300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON HEALTHCARE CADILLAC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-30
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic