Organization
KEVIN J. PIEBENGA D.P.M. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN PIEBENGA (PRESIDENT)
61666697525
Entity
Organization
Contact information
Practice address
3330 CENTRAL BOULEVARD, HUDSONVILLE, MI 49426-4114
(616) 669-7525
(616) 669-9952
Mailing address
3330 CENTRAL BLVD, HUDSONVILLE, MI 49426-1441
(616) 669-7525
(616) 669-9952
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2693413
—
MI
Enumeration date
04/11/2012
Last updated
04/11/2012
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