Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kevin J Wiersum, PAC

Individual provider Surgical Physician Assistant · NPI 1699762765

Kevin J Wiersum, PAC is a Physician Assistant in Grand Rapids, Michigan. Qualified in 2003, 23 years ago. Practices with Orthopaedic Associates of Grand Rapids PC, a 86-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
23
Licensed in
MI
In the registry since
2005
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

1111 Leffingwell Ave NE Ste 100
Grand Rapids, MI 49525-6406
Phone: (616) 459-7101
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 5601004099 (MI)

Record details

NPI number1699762765
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedOctober 4, 2005
Last updated in NPPESSeptember 18, 2013

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice Orthopaedic Associates Of Grand Rapids Pc — 86 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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