Provider Demographics
NPI:1982616942
Name:METZ, MICHAEL FRANCIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:METZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9177 OLD POTOSI RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-9437
Mailing Address - Country:US
Mailing Address - Phone:608-723-4300
Mailing Address - Fax:608-723-7885
Practice Address - Street 1:9177 OLD POTOSI RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-9437
Practice Address - Country:US
Practice Address - Phone:608-723-4300
Practice Address - Fax:608-723-7885
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI742-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42942800Medicaid
WI42942800Medicaid
WI24135Medicare ID - Type Unspecified