Provider Demographics
NPI:1851452403
Name:METCALF, HILARY A (MD)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:A
Last Name:METCALF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 LAKESHOR DR
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849
Mailing Address - Country:US
Mailing Address - Phone:906-485-2687
Mailing Address - Fax:906-485-2753
Practice Address - Street 1:901 LAKESHOR DR
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849
Practice Address - Country:US
Practice Address - Phone:906-485-2687
Practice Address - Fax:906-485-2753
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068698174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080E21007OtherBCBS PIN
MI104188747Medicaid
MIHG068698OtherBCBS LICENSE
MI0E26014004Medicare ID - Type Unspecified
MI104188747Medicaid