Healthcare Provider Details

I. General information

NPI: 1750333092
Provider Name (Legal Business Name): MICHAEL HAWKES METCALF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 SIDEWINDER DR
PARK CITY UT
84060-7492
US

IV. Provider business mailing address

1820 SIDEWINDER DR
PARK CITY UT
84060-7492
US

V. Phone/Fax

Practice location:
  • Phone: 435-655-6600
  • Fax: 435-655-2388
Mailing address:
  • Phone: 435-655-6600
  • Fax: 435-655-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number4956934-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: