Provider Demographics
NPI:1417904756
Name:METROPOLITAN MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:METROPOLITAN MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-967-3550
Mailing Address - Street 1:4495 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1611
Mailing Address - Country:US
Mailing Address - Phone:414-967-3550
Mailing Address - Fax:414-967-3551
Practice Address - Street 1:4495 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1611
Practice Address - Country:US
Practice Address - Phone:414-967-3550
Practice Address - Fax:414-967-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41916000Medicaid
612428500OtherDEPT OF LABOR
WI41916000Medicaid
52C0001073Medicare Oscar/Certification