Individual
ERIN KAVANAGH KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
221 MICHIGAN ST NE STE 400, GRAND RAPIDS, MI 49503-2543
(616) 486-9600
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
(616) 267-9295
(616) 267-9296
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
016874
NY
363AS0400X
Surgical Physician Assistant
Primary
5601007868
MI
Other
Enumeration date
10/30/2013
Last updated
02/25/2021
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