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General NPI Number Information
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NPI Number | 1093991101
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Entity Type | Organization
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Legal Business Name | MEDIC PODIATRY AND WOUND CARE
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 3191 HARBOR BLVD UNIT D
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6755
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Country | US
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Telephone | 941-613-1919
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Fax | 941-613-4077
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Provider Business Mailing Address
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Address Line | 3191 HARBOR BLVD UNIT D
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6755
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Country | US
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Telephone | 941-613-1919
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Fax | 941-613-4077
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Authorized Official
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Title or Position | PODIATRIST/OWNER
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Name | DR. MICHAEL R METYK
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Credential | DPM
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Telephone | 941-613-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2884
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License Number State | FL
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