Provider Demographics
NPI:1992204341
Name:JAWAD A SHAH MD PC
Entity Type:Organization
Organization Name:JAWAD A SHAH MD PC
Other - Org Name:INSIGHT WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:4400 S SAGINAW ST STE 1370
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2668
Mailing Address - Country:US
Mailing Address - Phone:810-732-8336
Mailing Address - Fax:810-213-0239
Practice Address - Street 1:4400 S SAGINAW ST STE 1370
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2668
Practice Address - Country:US
Practice Address - Phone:810-732-8336
Practice Address - Fax:810-213-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder