# MUNSON MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699174730
- **Authorized official:** KATHLEEN LARAIA (VP ANCILLARY SERVICES)
- **Authorized official phone:** (231) 392-8410

## Contact information

- **Practice address:** 2513 MOMENTUM PL, CHICAGO, IL 60689-5325
- **Practice address phone:** (231) 935-8031
- **Practice address fax:** (231) 935-6081
- **Mailing address:** 2513 MOMENTUM PL, CHICAGO, IL 60689-5325
- **Mailing address phone:** (231) 935-8031
- **Mailing address fax:** (231) 935-6081

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | — | MI | Yes |
| 363A00000X | Physician Assistant | 5601002557 | MI | — |
| 363A00000X | Physician Assistant | 5601004425 | MI | — |
| 363A00000X | Physician Assistant | 5601005943 | MI | — |
| 363A00000X | Physician Assistant | 5601006097 | MI | — |
| 363LA2100X | Acute Care Nurse Practitioner | 4704212770 | MI | — |
| 363LA2100X | Acute Care Nurse Practitioner | 4704253480 | MI | — |
| 363LA2100X | Acute Care Nurse Practitioner | 4704299582 | MI | — |

## Other

- **Enumeration date:** 08/14/2014
- **Last updated:** 04/01/2024