Provider Demographics
NPI:1629193446
Name:METROPOLITAN INTERNISTS, PA
Entity Type:Organization
Organization Name:METROPOLITAN INTERNISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-339-7171
Mailing Address - Street 1:825 S 8TH ST
Mailing Address - Street 2:SUITE #600 PARKSIDE PROF BLDG
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1208
Mailing Address - Country:US
Mailing Address - Phone:612-339-7171
Mailing Address - Fax:612-339-2885
Practice Address - Street 1:825 S 8TH ST
Practice Address - Street 2:SUITE #600 PARKSIDE PROF BLDG
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1208
Practice Address - Country:US
Practice Address - Phone:612-339-7171
Practice Address - Fax:612-339-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN207RG0100XOtherTAXONOMY
MNCP8684OtherRR MEDICARE
MN11168MEOtherBLUE CROSS BLUE SHIELD
MN11168MEOtherBLUE CROSS BLUE SHIELD