Provider Demographics
NPI:1568406593
Name:METKE, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:METKE
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 1:8010 SUMMERLIN LAKES DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1849
Mailing Address - Country:US
Mailing Address - Phone:239-939-1767
Mailing Address - Fax:239-939-5895
Practice Address - Street 1:8010 SUMMERLIN LAKES DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1849
Practice Address - Country:US
Practice Address - Phone:239-939-1767
Practice Address - Fax:239-939-5895
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40149208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00144596OtherRAILROAD MEDICARE
FL36329OtherBLUE SHIELD
3568049OtherAETNA HMO
7864548OtherAETNA PPO
FL36329AMedicare ID - Type Unspecified
P00144596OtherRAILROAD MEDICARE