Healthcare Provider Details

I. General information

NPI: 1306819073
Provider Name (Legal Business Name): DAN RUSSELL METCALF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 MAPLE LANE
ASHLAND WI
54806
US

IV. Provider business mailing address

1615 MAPLE LANE
ASHLAND WI
54806
US

V. Phone/Fax

Practice location:
  • Phone: 715-685-5500
  • Fax: 715-682-4022
Mailing address:
  • Phone: 715-685-5500
  • Fax: 715-682-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number47992
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: