Healthcare Provider Details

I. General information

NPI: 1811327844
Provider Name (Legal Business Name): METRO HEART & VASCULAR INSTITUTE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 COMMERCE DR
ALGONQUIN IL
60102-5916
US

IV. Provider business mailing address

1479 COMMERCE DR
ALGONQUIN IL
60102-5916
US

V. Phone/Fax

Practice location:
  • Phone: 847-637-5333
  • Fax: 866-420-6287
Mailing address:
  • Phone: 847-637-5333
  • Fax: 866-420-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036128795
License Number StateIL

VIII. Authorized Official

Name: KERI RENWICK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 847-637-5333