MEDICARE: JODI M METZ MS, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1558521401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI M METZ MS, PA-C

Provider Business Mailing Address
First Line	:	500 E GRANT ST
Second Line	:	2108
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1421
Country	:	US
Telephone Number	:	651-271-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1536 HEWITT AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1205
Country	:	US
Telephone Number	:	651-523-2204
Fax Number	:	651-523-2820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	10/21/2014

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