Provider Demographics
NPI:1396877320
Name:METROPOLITAN MEDICAL CONSULTANTS, S.C.
Entity type:Organization
Organization Name:METROPOLITAN MEDICAL CONSULTANTS, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FEDERBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-776-4923
Mailing Address - Street 1:832 W OAKDALE AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5111
Mailing Address - Country:US
Mailing Address - Phone:630-776-4923
Mailing Address - Fax:630-629-3901
Practice Address - Street 1:2333 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:773-506-7340
Practice Address - Fax:773-506-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215674OtherBCBC-IL GRP PROV # FOR GROUP NAMED: METROPOLITAN MEDICAL CONSULTANTS, S.C.
IL036056863Medicaid
IL787360OtherMEDICARE GROUP PROV # FOR GROUP NAMED: METROPOLITAN MEDICAL CONSULTANTS, S.C.
IL036056863Medicaid
IL787360OtherMEDICARE GROUP PROV # FOR GROUP NAMED: METROPOLITAN MEDICAL CONSULTANTS, S.C.