Provider Demographics
NPI:1225074826
Name:PAWAR, SHIWAJI DATTATRAY (MD)
Entity Type:Individual
Prefix:
First Name:SHIWAJI
Middle Name:DATTATRAY
Last Name:PAWAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 IRON POINT RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8707
Mailing Address - Country:US
Mailing Address - Phone:916-817-5438
Mailing Address - Fax:916-817-5415
Practice Address - Street 1:2155 IRON POINT RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8707
Practice Address - Country:US
Practice Address - Phone:916-817-5438
Practice Address - Fax:916-817-5415
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072268208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1225074826Medicaid
MI200000021644OtherPHP
MI3502900692OtherBCBSM
MI4711870-10Medicaid
MI0990418OtherHEALTHPLUS COMMERCIAL
MI1014600OtherMCLAREN HEALTH PLAN
MI1006816OtherMCLAREN HEALTH PLAN
MI4306770-10Medicaid
MI1014600OtherMCLAREN HEALTH PLAN