Provider Demographics
NPI:1548226384
Name:MEDIC INFUSION INC
Entity Type:Organization
Organization Name:MEDIC INFUSION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:METYK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-613-1919
Mailing Address - Street 1:1441 TAMIAMI TRL
Mailing Address - Street 2:SUITE 341
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1098
Mailing Address - Country:US
Mailing Address - Phone:941-613-1919
Mailing Address - Fax:941-613-4077
Practice Address - Street 1:1441 TAMIAMI TRL
Practice Address - Street 2:SUITE 341
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1098
Practice Address - Country:US
Practice Address - Phone:941-613-1919
Practice Address - Fax:941-613-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2884213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65672ZMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
U81722Medicare UPIN
FLK9600Medicare ID - Type UnspecifiedGROUP NUMBER