Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO2884 | FL |
Y | 222Z00000X | Podiatrist | PO2884 | FL |
NPI | 1043292378 |
---|---|
Provider Name | Dr. Michael R Metyk |
First Address | Port Charlotte, FL 33952-6755 |
Second Address | Port Charlotte, FL 33952-6755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 02/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2700250 | UHC (01) | FL |
340547800 | (05) | FL |
480031773 | RAILROAD MEDICARE (01) | FL |
65672 | BCBS (01) | FL |
P00259291 | RAILROAD MEDICARE (01) | FL |
U81722 | (02) | FL |