Provider Demographics
NPI:1649579764
Name:MUNSON MEDICAL CENTER
Entity Type:Organization
Organization Name:MUNSON MEDICAL CENTER
Other - Org Name:MUNSON HEMATOLOGY ONCOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-5000
Mailing Address - Street 1:3537 W FRONT ST
Mailing Address - Street 2:STE. H
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7941
Mailing Address - Country:US
Mailing Address - Phone:231-935-8890
Mailing Address - Fax:231-935-8894
Practice Address - Street 1:3537 W FRONT ST
Practice Address - Street 2:STE. H
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7941
Practice Address - Country:US
Practice Address - Phone:231-935-8890
Practice Address - Fax:231-935-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014578207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty