Provider Demographics
NPI:1609829365
Name:JIWANI, SHABANA (MD)
Entity Type:Individual
Prefix:
First Name:SHABANA
Middle Name:
Last Name:JIWANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 S POTOMAC ST
Mailing Address - Street 2:130
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4505
Mailing Address - Country:US
Mailing Address - Phone:303-337-5575
Mailing Address - Fax:303-745-6264
Practice Address - Street 1:1360 S POTOMAC ST
Practice Address - Street 2:130
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4505
Practice Address - Country:US
Practice Address - Phone:303-337-5575
Practice Address - Fax:303-745-6264
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1362847Medicaid
CO1362847Medicaid
CO1362847Medicaid