MEDICARE: METROPOLITAN DIAGNOSTICS

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1740871029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPOLITAN DIAGNOSTICS

Provider Business Mailing Address
First Line	:	514 N 57TH ST
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62203-1304
Country	:	US
Telephone Number	:	618-772-2721
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 N 57TH ST
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62203-1304
Country	:	US
Telephone Number	:	618-772-2721
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RANITA A. WALKER
Credential	:	CPT
Telephone Number	:	618-772-2721

Provider Enumeration Date	:	01/29/2021
Last Update Date	:	01/29/2021

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Directions to “METROPOLITAN DIAGNOSTICS ” Practice Location

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