Provider Demographics
NPI:1891729497
Name:METRO CARDIOLOGY GROUP LTD
Entity Type:Organization
Organization Name:METRO CARDIOLOGY GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANULLAH
Authorized Official - Middle Name:KHAN
Authorized Official - Last Name:PATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-239-3356
Mailing Address - Street 1:4600 MEMORIAL DR
Mailing Address - Street 2:MEDICAL CENTER 2 STE 420
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5366
Mailing Address - Country:US
Mailing Address - Phone:618-239-3356
Mailing Address - Fax:618-239-3359
Practice Address - Street 1:4600 MEMORIAL DR STE 420
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5366
Practice Address - Country:US
Practice Address - Phone:618-239-3356
Practice Address - Fax:618-239-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08200472OtherBCBS
2507179OtherUHC
146897XXOtherPREFERRED CARE
D14712OtherMERCY HEALTH PLAN
IL036060909Medicaid
0938287001OtherCIGNA
MO100789OtherBCBS
7661OtherGHP CMR
101463OtherHEALTHLINK
ILCA5095OtherRR MEDICARE
2102754OtherAETNA
140491OtherPHCS
PA1495152OtherBCBS
7661OtherGHP CMR
140491OtherPHCS
D14712OtherMERCY HEALTH PLAN