Healthcare Provider Details

I. General information

NPI: 1407051410
Provider Name (Legal Business Name): JANE J JAWAHIR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 PRAIRIE ST SW STE 112
GRANDVILLE MI
49418-2076
US

IV. Provider business mailing address

PO BOX 120125
GRAND RAPIDS MI
49528-0103
US

V. Phone/Fax

Practice location:
  • Phone: 616-235-2090
  • Fax: 616-235-2099
Mailing address:
  • Phone: 616-235-2090
  • Fax: 616-235-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM SWISHER
Title or Position: BILLING
Credential:
Phone: 616-235-2090