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

Mason J Vredeveld

Individual provider Physician Assistant · NPI 1164248142

Mason J Vredeveld is a Physician Assistant in Grand Rapids, Michigan. Qualified in 2025, 1 year ago. Licensed in Michigan.

Years since qualifying
1
Licensed in
MI
In the registry since
2024

Practice location Address checks out

100 Michigan St NE
Grand Rapids, MI 49503-2560
Phone: (616) 885-5000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601013872 (MI)

Record details

NPI number1164248142
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedNovember 25, 2024
Last updated in NPPESJune 22, 2026
Certification dateJune 22, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Grand Rapids