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General NPI Number Information
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NPI Number | 1083767479
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Entity Type | Organization
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Legal Business Name | METRO EAST HEALTHCARE LIMITED
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2133 VADALABENE DR STE 5B
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City | MARYVILLE
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State | IL
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Zip | 62062-5839
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Country | US
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Telephone | 618-288-7605
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Fax | 618-288-7644
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Provider Business Mailing Address
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Address Line | PO BOX 866
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-0866
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Country | US
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Telephone | 618-288-7605
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Fax | 618-288-7644
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Authorized Official
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Title or Position | OWNER
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Name | HARESH K. MOTWANI
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Credential | MD
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Telephone | 618-288-7605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-117061
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License Number State | IL
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