MEDICARE: METROPOLITAN MEDICAL CENTER, 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	261QA1903X	Ambulatory Surgical Clinic/Center

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
2	612428500	OTHER		DEPT OF LABOR

General Provider Information

NPI Number	:	1417904756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPOLITAN MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	4495 N OAKLAND AVE
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-1611
Country	:	US
Telephone Number	:	414-967-3550
Fax Number	:	414-967-3551

Provider Business Practice Location Address
First Line	:	4495 N OAKLAND AVE
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-1611
Country	:	US
Telephone Number	:	414-967-3550
Fax Number	:	414-967-3551

Authorized Official
Title or Position	:	BILLING
Name	:	MICHELLE ELERT
Credential	:
Telephone Number	:	414-967-3550

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	04/24/2012

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