Provider Demographics
NPI:1861577389
Name:MUNSON HEALTHCARE MANISTEE HOSPITAL
Entity type:Organization
Organization Name:MUNSON HEALTHCARE MANISTEE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO MUNSON PHYSICIAN NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUSZKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-4995
Mailing Address - Street 1:1391 E PARKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9352
Mailing Address - Country:US
Mailing Address - Phone:231-398-1760
Mailing Address - Fax:
Practice Address - Street 1:1391 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9352
Practice Address - Country:US
Practice Address - Phone:231-398-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088410207Q00000X
207V00000X, 207X00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty