Basic Information
| Provider Information | |||||||||
| NPI: | 1851385553 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | METZ | ||||||||
| FirstName: | SLOAN | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 W DIVERSEY PKWY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606141454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735425203 | ||||||||
| FaxNumber: | 7735425841 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 W 26TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606233824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735425203 | ||||||||
| FaxNumber: | 7735425841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | 016-004617 | IL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 016004617 | 05 | IL | MEDICAID | 016-004617-4 | 05 | IL | MEDICAID |