Healthcare Provider Details

I. General information

NPI: 1780178699
Provider Name (Legal Business Name): JAWAD A SHAH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S SAGINAW ST STE 1800
FLINT MI
48507-2677
US

IV. Provider business mailing address

4800 S SAGINAW ST STE 1800
FLINT MI
48507-2677
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-8336
  • Fax:
Mailing address:
  • Phone: 810-732-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD NADIR IJAZ
Title or Position: BUSINESS MANAGER
Credential:
Phone: 810-732-8336