Healthcare Provider Details

I. General information

NPI: 1942402391
Provider Name (Legal Business Name): JAWAD A SHAH, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S SAGINAW ST STE 1805
FLINT MI
48507-2669
US

IV. Provider business mailing address

4800 S SAGINAW ST STE 1800
FLINT MI
48507-2669
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-8336
  • Fax: 810-239-4346
Mailing address:
  • Phone: 810-732-8336
  • Fax: 810-239-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. JAWAD A SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 810-732-8336