Provider Demographics
NPI:1144413766
Name:METRO CARDIOVASCULAR CONSULTANTS, LTD
Entity Type:Organization
Organization Name:METRO CARDIOVASCULAR CONSULTANTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-229-0300
Mailing Address - Street 1:9115 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1895
Mailing Address - Country:US
Mailing Address - Phone:708-229-0300
Mailing Address - Fax:708-229-0303
Practice Address - Street 1:9115 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1895
Practice Address - Country:US
Practice Address - Phone:708-229-0300
Practice Address - Fax:708-229-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36076049207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076049Medicaid
IN200094400AMedicaid
IN514882742002OtherBCBS INDIANA
IL1605276OtherBCBS
IN877700Medicare PIN
IN514882742002OtherBCBS INDIANA
IL036076049Medicaid