Basic Information
| Provider Information | |||||||||
| NPI: | 1104895051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | METZLER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | HERMAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2500 ROCKY MOUNTAIN AVE | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702037000 | ||||||||
| FaxNumber: | 9702037055 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 ROCKY MOUNTAIN AVE | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702037000 | ||||||||
| FaxNumber: | 9702037055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 12/26/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | DR.0051220 | CO | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | DR.0051220 | CO | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 99879824 | 05 | CO | MEDICAID | 100503945 | 05 | NV | MEDICAID | XPY205012 | 05 | CA | MEDICAID | 914764 | 05 | AZ | MEDICAID |