Healthcare Provider Details

I. General information

NPI: 1720037138
Provider Name (Legal Business Name): PREFERRED PODIATRY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 SW 6TH AVE
OAK HARBOR WA
98277-2377
US

IV. Provider business mailing address

PO BOX 772294
DETROIT MI
48277-0917
US

V. Phone/Fax

Practice location:
  • Phone: 847-504-5000
  • Fax:
Mailing address:
  • Phone: 847-504-5000
  • Fax: 844-443-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVIN KESTNER
Title or Position: PRESIDENT
Credential:
Phone: 847-504-5002