Provider Demographics
NPI:1538260088
Name:METRO MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:METRO MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-422-6415
Mailing Address - Street 1:3228 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2314
Mailing Address - Country:US
Mailing Address - Phone:708-422-6415
Mailing Address - Fax:708-422-6534
Practice Address - Street 1:3228 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2314
Practice Address - Country:US
Practice Address - Phone:708-422-6415
Practice Address - Fax:708-422-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590380Medicare ID - Type UnspecifiedPROVIDER NUMBER