Individual provider · Type 1 NPI

Kevin J. Wiersum, PAC

Surgical Physician Assistant · Grand Rapids, MI

NPI number 1699762765 Active

Practice location

1111 Leffingwell Ave NE, Ste 100
Grand Rapids, MI 49525-6406

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X5601004099 (MI)

Surgical Physician Assistant: Definition to come...

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About NPI 1699762765

Kevin J. Wiersum, PAC's National Provider Identifier is 1699762765, issued on Oct 4, 2005. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Grand Rapids, MI. The record was last updated on Sep 18, 2013.