Provider Demographics
NPI:1689000903
Name:SIETSEMA, CASEY LEVI (PA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LEVI
Last Name:SIETSEMA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8666 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-9157
Mailing Address - Country:US
Mailing Address - Phone:616-283-8785
Mailing Address - Fax:
Practice Address - Street 1:8666 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-9157
Practice Address - Country:US
Practice Address - Phone:616-283-8785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006819363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical