Provider Demographics
NPI:1811327844
Name:METRO HEART & VASCULAR INSTITUTE LTD
Entity type:Organization
Organization Name:METRO HEART & VASCULAR INSTITUTE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:RENWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-637-5333
Mailing Address - Street 1:1479 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5916
Mailing Address - Country:US
Mailing Address - Phone:847-637-5333
Mailing Address - Fax:866-420-6287
Practice Address - Street 1:1479 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5916
Practice Address - Country:US
Practice Address - Phone:847-637-5333
Practice Address - Fax:866-420-6287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128795207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100113629Medicare PIN
ILDU7608Medicare PIN