Healthcare Provider Details

I. General information

NPI: 1508137076
Provider Name (Legal Business Name): HEATHER MARIE METCALF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2012
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6236
  • Fax: 608-417-6377
Mailing address:
  • Phone: 608-829-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number63846-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: