Provider Demographics
NPI:1255613642
Name:METRO FOOT SPECIALISTS, LLC
Entity type:Organization
Organization Name:METRO FOOT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOZLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:636-938-5006
Mailing Address - Street 1:3927 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-3009
Mailing Address - Country:US
Mailing Address - Phone:636-938-5006
Mailing Address - Fax:
Practice Address - Street 1:1747 SMIZER STATION RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2784
Practice Address - Country:US
Practice Address - Phone:636-938-5006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5354160002Medicare NSC
MO000014527Medicare PIN