Healthcare Provider Details

I. General information

NPI: 1992204341
Provider Name (Legal Business Name): JAWAD A SHAH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 S SAGINAW ST STE 1370
FLINT MI
48507-2668
US

IV. Provider business mailing address

4400 S SAGINAW ST STE 1370
FLINT MI
48507-2668
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-8336
  • Fax: 810-213-0239
Mailing address:
  • Phone: 810-732-8336
  • Fax: 810-213-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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