MEDICARE: SHIWAJI DATTATRAY PAWAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301072268	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	200000021644	OTHER	MI	PHP
3	3502900692	OTHER	MI	BCBSM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0990418	OTHER	MI	HEALTHPLUS COMMERCIAL
6	1014600	OTHER	MI	MCLAREN HEALTH PLAN
7	1006816	OTHER	MI	MCLAREN HEALTH PLAN
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225074826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIWAJI DATTATRAY PAWAR M.D.

Provider Business Mailing Address
First Line	:	2155 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-8707
Country	:	US
Telephone Number	:	916-817-5438
Fax Number	:	916-817-5415

Provider Business Practice Location Address
First Line	:	2155 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-8707
Country	:	US
Telephone Number	:	916-817-5438
Fax Number	:	916-817-5415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	12/15/2021

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Directions to “ SHIWAJI DATTATRAY PAWAR M.D.” Practice Location

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