Provider Demographics
NPI:1265494108
Name:METZLER, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:METZLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14824 BROOK HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7931
Mailing Address - Country:US
Mailing Address - Phone:319-354-3998
Mailing Address - Fax:319-354-1398
Practice Address - Street 1:14824 BROOK HILL DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7931
Practice Address - Country:US
Practice Address - Phone:319-354-3998
Practice Address - Fax:319-354-1398
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31540207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0218628Medicaid
IA23654OtherBLUE CROSS BLUE SHIELD
IAI0729Medicare ID - Type Unspecified
IA0218628Medicaid