| Organization Name: | KEVIN J. PIEBENGA D.P.M. P.C. |
| NPI Number: | 1215293550 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN PIEBENGA (PRESIDENT) |
| Mailing Address: | 3330 Central Boulevard Hudsonville |
| State: | MI US |
| Postal Code: | 494264114 |
| Phone Number: | 6166697525 |
| Fax Number: | 6166699952 |
| NPI Enumeration Date: | 04/11/2012 |
| NPI Last Update Date: | 04/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |