Healthcare Provider Details

I. General information

NPI: 1740871029
Provider Name (Legal Business Name): METROPOLITAN DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N 57TH ST
EAST SAINT LOUIS IL
62203-1304
US

IV. Provider business mailing address

514 N 57TH ST
EAST SAINT LOUIS IL
62203-1304
US

V. Phone/Fax

Practice location:
  • Phone: 618-772-2721
  • Fax:
Mailing address:
  • Phone: 618-772-2721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: RANITA A. WALKER
Title or Position: OWNER
Credential: CPT
Phone: 618-772-2721