Healthcare Provider Details

I. General information

NPI: 1578141933
Provider Name (Legal Business Name): RADWA ELSHARAWI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE STE 130
GRAND RAPIDS MI
49546-3680
US

IV. Provider business mailing address

1000 E PARIS AVE SE STE 130
GRAND RAPIDS MI
49546-3680
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-2001
  • Fax: 616-949-8620
Mailing address:
  • Phone: 616-949-2001
  • Fax: 616-949-8620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301513826
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: