Provider Demographics
NPI:1356650915
Name:METROEAST ENDOSCOPY CENTRE
Entity Type:Organization
Organization Name:METROEAST ENDOSCOPY CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-239-0678
Mailing Address - Street 1:5023 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3453
Mailing Address - Country:US
Mailing Address - Phone:618-239-0678
Mailing Address - Fax:800-516-2392
Practice Address - Street 1:5023 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3453
Practice Address - Country:US
Practice Address - Phone:618-239-0678
Practice Address - Fax:800-516-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107831261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical