Organization
METRO MEDICAL CLINIC, LLC
Active
Other names
Metro Medical Clinic, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAWED H SIDDIQUI MD (MEDICAL DOCTOR)
(314) 921-6200
Entity
Organization
Contact information
Practice address
5000 CEDAR PLAZA PKWY STE 300, SAINT LOUIS, MO 63128-3891
(314) 647-9797
Mailing address
11115 NEW HALLS FERRY RD, FLORISSANT, MO 63033-7613
(314) 921-6200
(314) 830-0756
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
R6047
MO
207RC0000X
Cardiovascular Disease Physician
R6047
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200668739
—
MO
Enumeration date
07/27/2018
Last updated
10/20/2018
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