MEDICARE: METROPOLITAN UROLOGICAL SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1013093780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPOLITAN UROLOGICAL SPECIALISTS

Provider Business Mailing Address
First Line	:	630 EMERSON RD
Second Line	:	LOFT 404
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6745
Country	:	US
Telephone Number	:	314-995-9782
Fax Number	:

Provider Business Practice Location Address
First Line	:	11710 ADMINISTRATION DR
Second Line	:	SUITE # 22
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3407
Country	:	US
Telephone Number	:	314-645-6454
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS ANGLO
Credential	:	MD
Telephone Number	:	314-645-6454

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	08/22/2020

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