Provider Demographics
NPI:1821398322
Name:MUNSON MEDICAL GROUP
Entity Type:Organization
Organization Name:MUNSON MEDICAL GROUP
Other - Org Name:TRAVERSE HEART AND VASCULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:KONYHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-5800
Mailing Address - Street 1:1200 SIXTH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2369
Mailing Address - Country:US
Mailing Address - Phone:231-935-5800
Mailing Address - Fax:231-935-5822
Practice Address - Street 1:1200 SIXTH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2369
Practice Address - Country:US
Practice Address - Phone:231-935-5800
Practice Address - Fax:231-935-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-30
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty