Active NPI
Peter J Wiebenga, MD
- General Practice Physician
- Holland, MI
National Provider Identifier
1225003825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 4301032024
- Practice address
- 175 S Waverly Rd
Holland, MI 49423-7907 - Phone
- (616) 392-5222
- Fax
- (616) 392-3635
- NPI assigned
- Feb 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 4301032024 | MI | Primary |
Addresses
Primary practice location
175 S Waverly Rd
Holland, MI 49423-7907
Mailing address
175 S Waverly Rd
Holland, MI 49423-7907
Phone (616) 392-5222
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P32249 | Other | MI | PJW BCN |
| 4301032024 | Other | MI | PJW STATE |
| PW032024 | Other | MI | PJW BCBSMI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1225003825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 S WAVERLY RD",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494237907",
"telephone_number": "616-392-5222",
"fax_number": "616-392-3635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 S WAVERLY RD",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494237907",
"telephone_number": "616-392-5222",
"fax_number": "616-392-3635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEBENGA",
"first_name": "PETER",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-17",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MI",
"license": "4301032024",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PJW BCN",
"identifier": "P32249",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PJW STATE",
"identifier": "4301032024",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PJW BCBSMI",
"identifier": "PW032024",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.