Healthcare Provider Details

I. General information

NPI: 1750214110
Provider Name (Legal Business Name): WENDY MICHELE KOONTZ-BEATTY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7371 SILVER COVE CT
LINDEN MI
48451-8798
US

IV. Provider business mailing address

7371 SILVER COVE CT
LINDEN MI
48451-8798
US

V. Phone/Fax

Practice location:
  • Phone: 906-440-1590
  • Fax:
Mailing address:
  • Phone: 906-440-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number5302028034
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: