Provider Demographics
NPI:1003358482
Name:BENZIE-LEELANAU DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:BENZIE-LEELANAU DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:THORELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:231-882-4409
Mailing Address - Street 1:6051 FRANKFORT HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BENZONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49616-9558
Mailing Address - Country:US
Mailing Address - Phone:231-882-2116
Mailing Address - Fax:231-882-2204
Practice Address - Street 1:6051 FRANKFORT HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616-9558
Practice Address - Country:US
Practice Address - Phone:231-882-2116
Practice Address - Fax:231-882-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881719086Medicaid