Healthcare Provider Details

I. General information

NPI: 1396877320
Provider Name (Legal Business Name): METROPOLITAN MEDICAL CONSULTANTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 W IRVING PARK RD
CHICAGO IL
60618
US

IV. Provider business mailing address

832 W OAKDALE AVE APT 3F
CHICAGO IL
60657-5111
US

V. Phone/Fax

Practice location:
  • Phone: 773-506-7340
  • Fax: 773-506-7341
Mailing address:
  • Phone: 630-776-4923
  • Fax: 630-629-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN PAUL FEDERBUSCH
Title or Position: PRESIDEN
Credential: M.D.
Phone: 630-776-4923