Individual
DR. PETER J WIEBENGA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
175 S WAVERLY RD, HOLLAND, MI 49423-7907
(616) 392-5222
(616) 392-3635
Mailing address
175 S WAVERLY RD, HOLLAND, MI 49423-7907
(616) 392-5222
(616) 392-3635
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301032024
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301032024
PJW STATE
MI
01
—
P32249
PJW BCN
MI
01
—
PW032024
PJW BCBSMI
MI
Enumeration date
02/17/2006
Last updated
07/09/2007
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