Healthcare Provider Details

I. General information

NPI: 1306411657
Provider Name (Legal Business Name): SHAAN SHAHZAD MANAWAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OAKLAND DR
KALAMAZOO MI
49008-1282
US

IV. Provider business mailing address

1200 N STATE ST CT 2B300
LOS ANGELES CA
90089-1001
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-4600
  • Fax:
Mailing address:
  • Phone: 323-409-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberA207137
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351048522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: