Provider Demographics
NPI:1043292378
Name:METYK, MICHAEL ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:METYK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 HARBOR BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6755
Mailing Address - Country:US
Mailing Address - Phone:941-613-1919
Mailing Address - Fax:941-613-4077
Practice Address - Street 1:3191 HARBOR BLVD STE D
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6755
Practice Address - Country:US
Practice Address - Phone:941-613-1919
Practice Address - Fax:941-613-4077
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2884213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2700250OtherUHC
FL65672OtherBCBS
FLP00259291OtherRAILROAD MEDICARE
FL340547800Medicaid
FL480031773OtherRAILROAD MEDICARE
FLU81722Medicare UPIN
FL340547800Medicaid
FL4239450001Medicare NSC