Provider Demographics
NPI:1205077286
Name:MICHAEL L METZGER MD PA
Entity type:Organization
Organization Name:MICHAEL L METZGER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-515-0080
Mailing Address - Street 1:10151 ENTERPRISE CENTER BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3761
Mailing Address - Country:US
Mailing Address - Phone:561-515-0080
Mailing Address - Fax:561-300-8620
Practice Address - Street 1:10151 ENTERPRISE CENTER BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3761
Practice Address - Country:US
Practice Address - Phone:561-515-0080
Practice Address - Fax:561-300-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97956207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME97956OtherMEDICAL LICENSE
FL001004700Medicaid
FL001004700Medicaid
FLME97956OtherMEDICAL LICENSE