Provider Demographics
NPI:1033167226
Name:YAMBAO, JAIME T (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:T
Last Name:YAMBAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:4444 W BRISTOL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3153
Practice Address - Country:US
Practice Address - Phone:810-230-9500
Practice Address - Fax:810-230-0169
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301076901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010B560260OtherBCBSM
MI010B560260OtherBLUE CHOICE
MI080B513530OtherBLUE CARE NETWORK GROUP
MI010B560260OtherBLUE CARE NETWORK
MI0802511362OtherBLUE CROSS BLUE SHIELD IN
MI4743541Medicaid
MI010B560260OtherCOMMUNITY BLUE
MI1015329OtherMCLAREN HEALTH PLAN
MI080B513530OtherBLUE CROSS BLUE SHIELD GR
MI4891796Medicaid
MIH94308OtherHEALTH ALLIANCE PLAN
MI1015329OtherHEALTH ADVANTAGE NETWORK
MI0999611OtherHEALTHPLUS
MI4743541Medicaid