Provider Demographics
NPI:1134252273
Name:METROPOLITAN MD, SC
Entity type:Organization
Organization Name:METROPOLITAN MD, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RACHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-832-6700
Mailing Address - Street 1:2350 RAVINE WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7621
Mailing Address - Country:US
Mailing Address - Phone:847-832-6700
Mailing Address - Fax:847-832-9430
Practice Address - Street 1:2350 RAVINE WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7621
Practice Address - Country:US
Practice Address - Phone:847-832-6700
Practice Address - Fax:847-832-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360434092086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL189305Medicaid
IL189305Medicaid
ILH51984Medicare UPIN
ILD12552Medicare UPIN
ILL89305 908930Medicare ID - Type UnspecifiedDR. JOHN RACHEL