Individual ProviderRichard Arlen WallusPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address100 Michigan NW, Suite A721, Grand Rapids, MI 49503(616) 974-4493PECOS EnrollmentBased on the most recent information from CMS, provider Richard Arlen Wallus 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 4 days ago.Profile DetailsProvider ID1992886410Provider TypeIndividualFull NameWallus, Richard ArlenGenderMaleSole ProprietorNoEnumeration Date10/18/2006Last Updated2/4/2011Contact InformationPractice LocationPractice Address100 Michigan NW, Suite A721, Grand Rapids, MI 49503Phone(616) 974-4493FaxUnlisted FaxMailing LocationMailing Address100 Michigan St NE, Mc 845, Grand Rapids, MI 49503-2560PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense5601001365Michigan