# KENNETH A BORENITSCH D O P C

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

## Provider details

- **NPI number:** 1407120165
- **Authorized official:** DR. KENNETH ALBERT BORENITSCH D.O. (PRESIDENT)
- **Authorized official phone:** (231) 723-8521

## Contact information

- **Practice address:** 1237 E PARKDALE AVE, SUITE 2, MANISTEE, MI 49660-9353
- **Practice address phone:** (231) 723-8521
- **Practice address fax:** (231) 398-0478
- **Mailing address:** 1237 E PARKDALE AVE, SUITE 2, MANISTEE, MI 49660-9353
- **Mailing address phone:** (231) 723-8521
- **Mailing address fax:** (231) 398-0478

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 5101007441 | MI | Yes |

## Other

- **Enumeration date:** 02/28/2012
- **Last updated:** 02/27/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 015512665 | BCBSM | — |
| 05 | — | 1405970 | — | MI |