Basic Information
| Provider Information | |||||||||
| NPI: | 1245767243 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JAWAD A SHAH MD PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INSIGHT TOXICOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 S SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485072677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102759108 | ||||||||
| FaxNumber: | 8109632881 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 S SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485072677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102759108 | ||||||||
| FaxNumber: | 8109632881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHAH | ||||||||
| AuthorizedOfficialFirstName: | JAWAD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8107328336 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 23D2077430 | MI | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.