# METRO MEDICAL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Metro Medical Clinic, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922585389
- **Authorized official:** MR. JAWED H SIDDIQUI MD (MEDICAL DOCTOR)
- **Authorized official phone:** (314) 921-6200

## Contact information

- **Practice address:** 5000 CEDAR PLAZA PKWY STE 300, SAINT LOUIS, MO 63128-3891
- **Practice address phone:** (314) 647-9797
- **Mailing address:** 11115 NEW HALLS FERRY RD, FLORISSANT, MO 63033-7613
- **Mailing address phone:** (314) 921-6200
- **Mailing address fax:** (314) 830-0756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | R6047 | MO | Yes |
| 207RC0000X | Cardiovascular Disease Physician | R6047 | MO | — |

## Other

- **Enumeration date:** 07/27/2018
- **Last updated:** 10/20/2018