Provider Demographics
NPI:1750333092
Name:METCALF, MICHAEL HAWKES (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HAWKES
Last Name:METCALF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1820 SIDEWINDER DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7492
Mailing Address - Country:US
Mailing Address - Phone:435-655-6600
Mailing Address - Fax:435-655-2388
Practice Address - Street 1:1820 SIDEWINDER DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7492
Practice Address - Country:US
Practice Address - Phone:435-655-6600
Practice Address - Fax:435-655-2388
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT4956934-1205207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTTPRA09041OtherMOLINA ADVANTAGE
UT841433992MM2OtherEDUCATORS MUTUAL
UT49569348901001OtherSELECT HEALTH PLANS
UT68380OtherPUBLIC EMPLOYEES HEALTH
UT09-00368OtherUNITED HEALTH CARE
UT09-00368OtherUNITED HEALTH CARE