Provider Demographics
NPI:1982110524
Name:MUNSON HEALTHCARE CADILLAC
Entity Type:Organization
Organization Name:MUNSON HEALTHCARE CADILLAC
Other - Org Name:MUNSON HEALTHCARE CADILLAC ORTHOPAEDICS
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 1:8872 PROFESSIONAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8482
Mailing Address - Country:US
Mailing Address - Phone:231-779-0320
Mailing Address - Fax:231-779-1367
Practice Address - Street 1:8872 PROFESSIONAL DR STE B
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8482
Practice Address - Country:US
Practice Address - Phone:231-779-0320
Practice Address - Fax:231-779-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty