Healthcare Provider Details

I. General information

NPI: 1689465312
Provider Name (Legal Business Name): MICHIGAN MRT HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 COOLIDGE RD
EAST LANSING MI
48823-1379
US

IV. Provider business mailing address

5800 FOREMOST DR SE STE 200
GRAND RAPIDS MI
49546-7062
US

V. Phone/Fax

Practice location:
  • Phone: 517-999-5900
  • Fax: 517-999-5901
Mailing address:
  • Phone: 517-999-5900
  • Fax: 517-999-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: STUART GENSCHAW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 616-291-6048