Provider Demographics
NPI:1447590328
Name:METRO EAST GASTROENTEROLOGY LTD
Entity Type:Organization
Organization Name:METRO EAST GASTROENTEROLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREENSPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-222-3200
Mailing Address - Street 1:311 W LINCOLN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1902
Mailing Address - Country:US
Mailing Address - Phone:618-222-3200
Mailing Address - Fax:618-222-3203
Practice Address - Street 1:311 W LINCOLN ST STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1902
Practice Address - Country:US
Practice Address - Phone:618-222-3200
Practice Address - Fax:618-222-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095427207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095427Medicaid
IL036095427Medicaid