Individual ProviderDaniel J StalsonburgPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address100 Michigan Ave.NW, Suite A721, Grand Rapids, MI 49503(616) 974-4493PECOS EnrollmentBased on the most recent information from CMS, provider Daniel J Stalsonburg does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 10:37 AM.Profile DetailsProvider ID1720169246Provider TypeIndividualFull NameStalsonburg, Daniel JCredentialPAGenderMaleSole ProprietorNoEnumeration Date10/18/2006Last Updated1/31/2011Contact InformationPractice LocationPractice Address100 Michigan Ave.NW, Suite A721, Grand Rapids, MI 49503Phone(616) 974-4493FaxUnlisted FaxMailing LocationMailing Address100 Michigan St NE, Mc845, Grand Rapids, MI 49503-2560PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense5601004692Michigan