Metro Medical Clinic, LLC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

R6047 Issued in MO

Legal business name

METRO MEDICAL CLINIC, LLC

Practice address

5000 Cedar Plaza Pkwy Ste 300
Saint Louis, MO 63128-3891

Phone

(314) 647-9797

NPI assigned

Jul 27, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jawed H Siddiqui, MD

Title

Medical Doctor

Phone

(314) 921-6200

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Metro Medical Clinic, LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539993600000",
    "number": "1922585389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11115 NEW HALLS FERRY RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630337613",
            "telephone_number": "314-921-6200",
            "fax_number": "314-830-0756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 CEDAR PLAZA PKWY STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283891",
            "telephone_number": "314-647-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-27",
        "last_updated": "2018-10-20",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUI",
        "authorized_official_first_name": "JAWED",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "314-921-6200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MO",
            "license": "R6047",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "R6047",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200668739",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Metro Medical Clinic, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Metro Medical Clinic South LLC
• Metro Medical Institute
• Metro Saint Louis Dialysis Center
• Metro St Louis Renal Services, Inc
• Metro St Louis Surgery Center LLC
• Metro St. Louis Dialysis - Florissant LLC

• Adult Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Adult Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.