Organization
THE BOUTIQUE AT MERCY HEALTH LACKS CANCER CENTER
Active
Other names
Trinity Health Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW BIERSACK MD (PRESIDENT)
(616) 685-6413
Entity
Organization
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-5030
Mailing address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-5030
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
08/05/2008
Last updated
08/26/2022
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