Kenneth Albert Borenitsch, D.O.
Individual provider Active NPI General Practice Physician · Manistee, MI
NPI 1992852685 · NPPES record last updated Feb 27, 2014
Key facts
- NPI
- 1992852685
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 5101007441 (MI)
- Practice address
- 1237 E Parkdale Ave
Suite 2
Manistee, MI 49660-9353 - Phone
- (231) 723-8521
- Fax
- (231) 398-0478
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 5101007441 | MI | Yes |
Addresses
Primary practice location
1237 E Parkdale Ave
Suite 2
Manistee, MI 49660-9353
Mailing address
1237 E Parkdale Ave
Suite 2
Manistee, MI 49660-9353
Phone (231) 723-8521
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 015512665 | Other | MI | BLUE CROSS BLUE SHIELD OF MI |
| 1405970 | Medicaid | MI |
Other providers in Manistee, MI
- Blythe a O'Donnell, PLLC
- Richard Artin Bobian
- Fritz R Boehm
- Heidi L Boehm
- Stacey Bonecutter
- April May Bovee
- Jaime L Boyer
- Summer L Brave Bull
- Brian J McComb DO PLLC
- Sonya Broadbent
All providers in Manistee, MI · General Practice Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.