Healthcare Provider Details

I. General information

NPI: 1366577686
Provider Name (Legal Business Name): BENZIE LEELANAU DISTRICT HEALTH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 FRANKFORT HWY SUITE 100
BENZONIA MI
49616
US

IV. Provider business mailing address

6051 FRANKFORT HWY SUITE 100
BENZONIA MI
49616
US

V. Phone/Fax

Practice location:
  • Phone: 231-882-4409
  • Fax: 231-882-2204
Mailing address:
  • Phone: 231-882-4409
  • Fax: 231-882-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number4704147470
License Number StateMI

VIII. Authorized Official

Name: MR. DANIEL R. THORELL JR.
Title or Position: HEALTH OFFICER
Credential: MSA
Phone: 231-882-2102