Provider Demographics
NPI:1427096064
Name:METRO MEDICAL PRACTICE PC
Entity type:Organization
Organization Name:METRO MEDICAL PRACTICE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MENAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-524-9085
Mailing Address - Street 1:2891 E MAPLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6106
Mailing Address - Country:US
Mailing Address - Phone:248-524-9085
Mailing Address - Fax:248-524-9086
Practice Address - Street 1:2891 E MAPLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6106
Practice Address - Country:US
Practice Address - Phone:248-524-9085
Practice Address - Fax:248-524-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITU034870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F325720OtherBLUE CROSS BLUE SHIELD
MI0M03850Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER