Provider Demographics
NPI:1689465312
Name:MICHIGAN MRT HOLDINGS
Entity type:Organization
Organization Name:MICHIGAN MRT HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:GENSCHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-291-6048
Mailing Address - Street 1:2959 LUCERNE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7173
Mailing Address - Country:US
Mailing Address - Phone:517-999-5900
Mailing Address - Fax:517-999-5901
Practice Address - Street 1:2175 COOLIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1379
Practice Address - Country:US
Practice Address - Phone:517-999-5900
Practice Address - Fax:517-999-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation