MEDICARE: METRO MEDICAL NORTH COUNTY LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1306703038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO MEDICAL NORTH COUNTY LLC

Provider Business Mailing Address
First Line	:	11115 NEW HALLS FERRY RD STE 105
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-7610
Country	:	US
Telephone Number	:	314-921-6200
Fax Number	:	314-830-0756

Provider Business Practice Location Address
First Line	:	11115 NEW HALLS FERRY RD STE 105
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-7610
Country	:	US
Telephone Number	:	314-921-6200
Fax Number	:	314-830-0756

Authorized Official
Title or Position	:	OWNER
Name	:	JAWED H SIDDIQUI
Credential	:
Telephone Number	:	314-921-6200

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “METRO MEDICAL NORTH COUNTY LLC ” Practice Location

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