Provider Demographics
NPI:1427020452
Name:SHAH, JAWAD A (MD)
Entity type:Individual
Prefix:
First Name:JAWAD
Middle Name:A
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 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:STE1800
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
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082631174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104552773Medicaid
MII02357Medicare UPIN
MI0N85810Medicare ID - Type Unspecified