Provider Demographics
NPI:1447404991
Name:METRO CARDIOVASCULAR, INC.
Entity Type:Organization
Organization Name:METRO CARDIOVASCULAR, INC.
Other - Org Name:METRO HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAWED
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-921-6200
Mailing Address - Street 1:11115 NEW HALLS FERRY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7613
Mailing Address - Country:US
Mailing Address - Phone:314-921-6200
Mailing Address - Fax:314-830-0756
Practice Address - Street 1:11115 NEW HALLS FERRY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-7613
Practice Address - Country:US
Practice Address - Phone:314-921-6200
Practice Address - Fax:314-830-0756
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO CARDIOVASCULAR, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-11
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6047207R00000X
IL036-056278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110125678OtherRAILROAD MEDICARE
MO200668739Medicaid
IL7040870018Medicaid
IL901862Medicare PIN
MO110125678OtherRAILROAD MEDICARE
IL7040870018Medicaid