Provider Demographics
NPI:1902104029
Name:PIHL, KERENT DOMINIQUE (DO)
Entity Type:Individual
Prefix:DR
First Name:KERENT
Middle Name:DOMINIQUE
Last Name:PIHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1009 44TH ST SW
Mailing Address - Street 2:STE 101
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4480
Mailing Address - Country:US
Mailing Address - Phone:616-828-4622
Mailing Address - Fax:616-635-2552
Practice Address - Street 1:1009 44TH ST SW
Practice Address - Street 2:STE 101
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4480
Practice Address - Country:US
Practice Address - Phone:616-828-4622
Practice Address - Fax:616-635-2552
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019176208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery