Healthcare Provider Details

I. General information

NPI: 1124913033
Provider Name (Legal Business Name): ELIZA JUNE USIAK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MICHIGAN ST NE STE 200
GRAND RAPIDS MI
49503-3314
US

IV. Provider business mailing address

1 CAMPUS DRIVE 2015 JAMES H. ZUMBERGE HALL
ALLENDALE MI
49401-9403
US

V. Phone/Fax

Practice location:
  • Phone: 616-331-5700
  • Fax: 616-331-5999
Mailing address:
  • Phone: 616-331-5700
  • Fax: 616-331-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: