Provider Demographics
NPI:1972604825
Name:MUNAWAR, SHAKEEL
Entity Type:Individual
Prefix:
First Name:SHAKEEL
Middle Name:
Last Name:MUNAWAR
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 1:7312 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1903
Mailing Address - Country:US
Mailing Address - Phone:313-382-3844
Mailing Address - Fax:313-382-3844
Practice Address - Street 1:7312 PARK AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1903
Practice Address - Country:US
Practice Address - Phone:313-382-3844
Practice Address - Fax:313-382-3844
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237728Medicare Oscar/Certification