Provider Demographics
NPI:1023457231
Name:METZ, MICA (DO)
Entity type:Individual
Prefix:
First Name:MICA
Middle Name:
Last Name:METZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MICA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 VITALITY DR
Practice Address - Street 2:SUITE A
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-1373
Practice Address - Country:US
Practice Address - Phone:317-621-9220
Practice Address - Fax:317-355-8734
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11017373A207Q00000X
IN02004730A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201178140Medicaid
INP01777173OtherRR MEDICARE
IN201178140Medicaid