Provider Demographics
NPI:1144225541
Name:METCHICK, HEATHER MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:METCHICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 N CAUSEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5266
Mailing Address - Country:US
Mailing Address - Phone:386-427-4441
Mailing Address - Fax:386-427-4494
Practice Address - Street 1:433 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5266
Practice Address - Country:US
Practice Address - Phone:386-427-4441
Practice Address - Fax:386-427-4494
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89802207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H87048Medicare UPIN
FL378972Medicare ID - Type Unspecified