Healthcare Provider Details

I. General information

NPI: 1578819850
Provider Name (Legal Business Name): MAWAN SHUAYTO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 7TH ST STE A
PORT HURON MI
48060-5497
US

IV. Provider business mailing address

1103 7TH ST STE A
PORT HURON MI
48060-5497
US

V. Phone/Fax

Practice location:
  • Phone: 810-989-0000
  • Fax:
Mailing address:
  • Phone: 810-989-0000
  • Fax: 810-989-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARWAN I SHUAYTO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 810-989-0000