MEDICARE: LEIDY FOURNIER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601008126	MI

General Provider Information

NPI Number	:	1437693660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIDY FOURNIER PA-C

Provider Business Mailing Address
First Line	:	6690 CROSSINGS DR SE STE C
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-7394
Country	:	US
Telephone Number	:	616-600-1885
Fax Number	:

Provider Business Practice Location Address
First Line	:	6690 CROSSINGS DR SE STE C
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-7394
Country	:	US
Telephone Number	:	616-600-1885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	04/21/2026

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