MEDICARE: METROSTARS MEDICAL EQUIPMENT

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1023408424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROSTARS MEDICAL EQUIPMENT

Provider Business Mailing Address
First Line	:	6240 N 104TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-1406
Country	:	US
Telephone Number	:	262-352-6217
Fax Number	:

Provider Business Practice Location Address
First Line	:	6240 N 104TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-1406
Country	:	US
Telephone Number	:	262-352-6217
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TIMOTHY WABLONG LEE
Credential	:
Telephone Number	:	262-352-6217

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/23/2015

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