Provider Demographics
NPI:1740223239
Name:METRO MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:METRO MEDICAL PRACTICE PC
Other - Org Name:METRO MEDICAL PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MENAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-524-9085
Mailing Address - Street 1:2891 E MAPLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6106
Mailing Address - Country:US
Mailing Address - Phone:248-524-9085
Mailing Address - Fax:248-524-9086
Practice Address - Street 1:2891 E MAPLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6106
Practice Address - Country:US
Practice Address - Phone:248-524-9085
Practice Address - Fax:248-524-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISJ033023207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI132060OtherCARE CHOICES
MI101958265Medicaid
MI700F325720OtherBLUE CROSS BLUE SHIELD
MIM03850001Medicare PIN