MEDICARE: METRO CARDIOLOGY GROUP LTD

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	207RC0000X	Cardiovascular Disease Physician	036060909	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386023000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO CARDIOLOGY GROUP LTD

Provider Business Mailing Address
First Line	:	4600 MEMORIAL DR
Second Line	:	SUITE 420
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5368
Country	:	US
Telephone Number	:	618-239-3356
Fax Number	:	618-239-3359

Provider Business Practice Location Address
First Line	:	5020 N ILLINOIS ST
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-3411
Country	:	US
Telephone Number	:	618-239-3356
Fax Number	:	618-239-3359

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMANULLAH K PATHAN
Credential	:	M.D.
Telephone Number	:	618-239-3356

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	05/27/2015

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Directions to “METRO CARDIOLOGY GROUP LTD ” Practice Location

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