Provider Demographics
NPI:1942402391
Name:JAWAD A SHAH, MD PC
Entity Type:Organization
Organization Name:JAWAD A SHAH, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAWAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-732-8336
Mailing Address - Street 1:4800 S SAGINAW ST
Mailing Address - Street 2:STE 1800
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2669
Mailing Address - Country:US
Mailing Address - Phone:810-732-8336
Mailing Address - Fax:810-239-4346
Practice Address - Street 1:4800 S SAGINAW ST
Practice Address - Street 2:STE 1805
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2669
Practice Address - Country:US
Practice Address - Phone:810-732-8336
Practice Address - Fax:810-239-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X, 207LP2900X, 207T00000X, 2085N0700X, 2085R0202X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1427020452OtherINDIVIDUAL NPI NUMBER
MI1427020452OtherINDIVIDUAL NPI NUMBER