Healthcare Provider Details

I. General information

NPI: 1548914450
Provider Name (Legal Business Name): METRO URGENT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 04/20/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5406 W. FULLERTON AVE
CHICAGO IL
60639
US

IV. Provider business mailing address

5406 W. FULLERTON AVE
CHICAGO IL
60639
US

V. Phone/Fax

Practice location:
  • Phone: 786-301-4903
  • Fax:
Mailing address:
  • Phone: 773-466-7012
  • Fax: 773-466-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JOSE AYALA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 786-301-4903