Individual provider · Type 1 NPI

Madison Rae Tiesenga, PA-C

Physician Assistant · Grand Rapids, MI

NPI number 1912683541 Active

Practice location

4069 Lake Dr SE Ste 315
Grand Rapids, MI 49546-8816

Call (616) 267-7758 Map

Mailing address

100 Michigan St NE # MC845
Grand Rapids, MI 49503-2560

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000X5601011952 (MI)

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1912683541

Madison Rae Tiesenga, PA-C's National Provider Identifier is 1912683541, issued on Jun 27, 2023. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Grand Rapids, MI. The record was last updated on Sep 10, 2026.