Individual
MICA METZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
545 VITALITY DR, SUITE A, FORTVILLE, IN 46040-1373
(317) 621-9220
(317) 355-8734
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004730A
IN
207Q00000X
Family Medicine Physician
11017373A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201178140
—
IN
01
—
P01777173
RR MEDICARE
IN
Enumeration date
06/20/2013
Last updated
11/27/2023
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