Provider Demographics
NPI:1285180943
Name:FAWWAD, SHAIKH
Entity Type:Individual
Prefix:
First Name:SHAIKH
Middle Name:
Last Name:FAWWAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638775
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8775
Mailing Address - Country:US
Mailing Address - Phone:419-547-0340
Mailing Address - Fax:419-547-9130
Practice Address - Street 1:402 W MCPHERSON HWY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-1133
Practice Address - Country:US
Practice Address - Phone:419-547-0340
Practice Address - Fax:419-547-9130
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine