Provider Demographics
NPI:1861780082
Name:JAWAD A SHAH MD PC
Entity type:Organization
Organization Name:JAWAD A SHAH MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-275-9371
Mailing Address - Street 1:4800 S SAGINAW ST
Mailing Address - Street 2:SUITE 1805
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2677
Mailing Address - Country:US
Mailing Address - Phone:810-275-9108
Mailing Address - Fax:
Practice Address - Street 1:3390 N STATE RD
Practice Address - Street 2:SUITE B
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1154
Practice Address - Country:US
Practice Address - Phone:810-275-9610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAWAD A SHAH MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy