| Doctor Name: | DR. KEVIN JON PIEBENGA |
| NPI Number: | 1629034178 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M., P.C. |
| License Number: | 001527 |
| Business Practice Address: | 3330 Central Blvd Hudsonville, MI - 494261441 |
| Business Phone Number: | 6166697525 |
| Business Fax Number: | 6166699952 |
| Mailing Address: | 3330 Central Blvd, HUDSONVILLE |
| State: | MI |
| Postal Code: | 494261441 |
| Phone Number: | 6166697525 |
| Fax Number: | 6166699952 |
| NPI Enumeration Date: | 04/25/2006 |
| NPI Last Update Date: | 04/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 001527 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |