Healthcare Provider Details

I. General information

NPI: 1407851801
Provider Name (Legal Business Name): LEE NATHANIEL METCHICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 VICTORIA COMMONS BLVD
DELAND FL
32724-7700
US

IV. Provider business mailing address

141 VICTORIA COMMONS BLVD
DELAND FL
32724-7700
US

V. Phone/Fax

Practice location:
  • Phone: 386-427-4544
  • Fax: 386-427-8688
Mailing address:
  • Phone: 386-427-4544
  • Fax: 386-427-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number103096
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME89297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: