Provider Demographics
NPI:1902812092
Name:METCALFE, NICOLE PATRICE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:PATRICE
Last Name:METCALFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29255 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1018
Mailing Address - Country:US
Mailing Address - Phone:248-355-2852
Mailing Address - Fax:
Practice Address - Street 1:29255 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1018
Practice Address - Country:US
Practice Address - Phone:248-355-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074612207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4622090Medicaid
MI4622090Medicaid
MIH96092Medicare UPIN