Healthcare Provider Details

I. General information

NPI: 1356410161
Provider Name (Legal Business Name): TIMOTHY J METZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E 20TH ST STE 602
SIOUX FALLS SD
57105-1048
US

IV. Provider business mailing address

5105 S PENNBROOK AVE
SIOUX FALLS SD
57108-2990
US

V. Phone/Fax

Practice location:
  • Phone: 605-338-7098
  • Fax: 605-335-3505
Mailing address:
  • Phone: 605-338-0500
  • Fax: 605-335-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4713
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: