Individual
KEVIN J WIERSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1111 LEFFINGWELL AVE NE, STE 100, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
Mailing address
1111 LEFFINGWELL AVE NE, STE 100, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601004099
MI
Other
Enumeration date
10/04/2005
Last updated
09/18/2013
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