Provider Demographics
NPI:1679522387
Name:METZGER, STEVE
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:METZGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 N 33RD ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-7786
Mailing Address - Country:US
Mailing Address - Phone:701-220-3950
Mailing Address - Fax:
Practice Address - Street 1:104 3RD AVE NW
Practice Address - Street 2:#302
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3163
Practice Address - Country:US
Practice Address - Phone:701-663-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDCO003506222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0D14869Medicare ID - Type Unspecified