Provider Demographics
NPI:1659341741
Name:SHAWA, IMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:IMAD
Middle Name:
Last Name:SHAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IMAD
Other - Middle Name:
Other - Last Name:ALSHAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:701 E COUNTY LINE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1070
Mailing Address - Country:US
Mailing Address - Phone:317-885-2334
Mailing Address - Fax:317-885-2869
Practice Address - Street 1:701 E COUNTY LINE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1070
Practice Address - Country:US
Practice Address - Phone:317-885-2334
Practice Address - Fax:317-885-2869
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060327A207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200511510Medicaid
IN200511510Medicaid