Provider Demographics
NPI:1972532703
Name:JAWADI, M HUSAIN (MD)
Entity type:Individual
Prefix:
First Name:M
Middle Name:HUSAIN
Last Name:JAWADI
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 1:30 W MCCREIGHT AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1842
Mailing Address - Country:US
Mailing Address - Phone:937-342-4771
Mailing Address - Fax:937-342-4773
Practice Address - Street 1:30 W MCCREIGHT AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1842
Practice Address - Country:US
Practice Address - Phone:937-342-4771
Practice Address - Fax:937-342-4773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073824207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2061496Medicaid
OHJA0845081Medicare ID - Type Unspecified
OH2061496Medicaid