Healthcare Provider Details

I. General information

NPI: 1114988896
Provider Name (Legal Business Name): CANDACE SUE METCALF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

1540 LAKE LANSING RD SUITE G06
LANSING MI
48912-3756
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax: 517-364-1000
Mailing address:
  • Phone: 517-482-7246
  • Fax: 517-484-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5101011334
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: