Individual ProviderRalph WangPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansPractice Address235 Wealthy St SE, Grand Rapids, MI 49503-5247(616) 840-8005(708) 567-4538PECOS EnrollmentBased on the most recent information from CMS, provider Ralph Wang is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 10:10 AM.Profile DetailsProvider ID1679744833Provider TypeIndividualFull NameWang, RalphTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date3/17/2008Last Updated3/31/2021Contact InformationPractice LocationPractice Address235 Wealthy St SE, Grand Rapids, MI 49503-5247Phone(616) 840-8005Fax(616) 840-9642Mailing LocationMailing Address2180 West Manchester Rd, Wheaton, IL 60187Phone(708) 567-4538FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode208100000XPrimaryDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicense4301117210MichiganCode208100000XDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicenseBP10023392TexasCode208100000XDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicense036120935IllinoisProvider IdentifiersIDDescriptionIssuerID036120935-1DescriptionMedicaidIssuerUnlistedIllinois