Provider Demographics
NPI:1588049076
Name:METCALFE, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:METCALFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 MARONEAL ST UNIT 2013
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3255
Mailing Address - Country:US
Mailing Address - Phone:346-228-2608
Mailing Address - Fax:
Practice Address - Street 1:2222 MARONEAL ST UNIT 2013
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3255
Practice Address - Country:US
Practice Address - Phone:346-228-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
41090051OtherECFMG IDENTIFICATION
TXQ2804OtherTEXAS MEDICAL LICENSCE
CAMD-0071-2031OtherCANADIAN MINC: