Provider Demographics
NPI:1417612136
Name:PIERONI, KENDALL (PA-C)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:PIERONI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71587
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-0587
Mailing Address - Country:US
Mailing Address - Phone:248-268-4296
Mailing Address - Fax:888-850-3877
Practice Address - Street 1:928 E 10 MILE RD STE 400
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-3041
Practice Address - Country:US
Practice Address - Phone:248-268-4296
Practice Address - Fax:888-850-3877
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010822363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical