Provider Demographics
NPI:1700960622
Name:MUNSON MEDICAL CENTER
Entity Type:Organization
Organization Name:MUNSON MEDICAL CENTER
Other - Org Name:INFECTIOUS DISEASE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP ANCILLARY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARAIA
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:231-392-8410
Mailing Address - Street 1:1221 6TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2359
Mailing Address - Country:US
Mailing Address - Phone:231-935-5090
Mailing Address - Fax:231-935-5093
Practice Address - Street 1:1221 6TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2359
Practice Address - Country:US
Practice Address - Phone:231-935-5090
Practice Address - Fax:231-935-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI440B812420OtherBCBS GROUP NUMBER
MICB9942OtherRAILROAD GROUP
MI700B860160OtherBCBS GROUP PIN
MI0B81242Medicare PIN
MICB9942OtherRAILROAD GROUP