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General NPI Number Information
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NPI Number | 1689465312
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Entity Type | Organization
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Legal Business Name | MICHIGAN MRT HOLDINGS, LLC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2175 COOLIDGE RD
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City | EAST LANSING
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State | MI
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Zip | 48823-1379
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Country | US
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Telephone | 517-999-5900
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Fax | 517-999-5901
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Provider Business Mailing Address
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Address Line | 5800 FOREMOST DR SE STE 200
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7062
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Country | US
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Telephone | 517-999-5900
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Fax | 517-999-5901
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | STUART GENSCHAW
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Credential |
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Telephone | 616-291-6048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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