Provider Demographics
NPI:1386023000
Name:METRO CARDIOLOGY GROUP LTD
Entity Type:Organization
Organization Name:METRO CARDIOLOGY GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANULLAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-239-3356
Mailing Address - Street 1:4600 MEMORIAL DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5368
Mailing Address - Country:US
Mailing Address - Phone:618-239-3356
Mailing Address - Fax:618-239-3359
Practice Address - Street 1:5020 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3411
Practice Address - Country:US
Practice Address - Phone:618-239-3356
Practice Address - Fax:618-239-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060909207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060909Medicaid
P05754Medicare PIN
ILD14712Medicare UPIN