Provider Demographics
NPI:1033214549
Name:THE METABOLISM, WEIGHT, & LIFESTYLE INSTITUTE, LTD.
Entity Type:Organization
Organization Name:THE METABOLISM, WEIGHT, & LIFESTYLE INSTITUTE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:MOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-394-0846
Mailing Address - Street 1:637 S BRISTOL LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2709
Mailing Address - Country:US
Mailing Address - Phone:847-394-0846
Mailing Address - Fax:847-394-9255
Practice Address - Street 1:637 S BRISTOL LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2709
Practice Address - Country:US
Practice Address - Phone:847-394-0846
Practice Address - Fax:847-394-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042004051207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214417Medicare UPIN