Healthcare Provider Details

I. General information

NPI: 1780036384
Provider Name (Legal Business Name): SYED JAWAD SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 8TH AVE SE STE 200
CEDAR RAPIDS IA
52401-2106
US

IV. Provider business mailing address

788 SERVICE RD RM B301
EAST LANSING MI
48824-7013
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-6687
  • Fax:
Mailing address:
  • Phone: 517-353-5100
  • Fax: 517-432-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD-50601
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD-50601
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD-50601
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: