Provider Demographics
NPI:1083767479
Name:METRO EAST HEALTHCARE LIMITED
Entity Type:Organization
Organization Name:METRO EAST HEALTHCARE LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOTWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-288-7605
Mailing Address - Street 1:PO BOX 866
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-0866
Mailing Address - Country:US
Mailing Address - Phone:618-288-7605
Mailing Address - Fax:618-288-7644
Practice Address - Street 1:2133 VADALABENE DR STE 5B
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5839
Practice Address - Country:US
Practice Address - Phone:618-288-7605
Practice Address - Fax:618-288-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-117061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214790Medicare PIN