Provider Demographics
NPI:1407851801
Name:METCHICK, LEE NATHANIEL (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:NATHANIEL
Last Name:METCHICK
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 1:141 VICTORIA COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7700
Mailing Address - Country:US
Mailing Address - Phone:386-427-4544
Mailing Address - Fax:386-427-8688
Practice Address - Street 1:141 VICTORIA COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7700
Practice Address - Country:US
Practice Address - Phone:386-427-4544
Practice Address - Fax:386-427-8688
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89297207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378982Medicare ID - Type Unspecified
I14144Medicare UPIN