Provider Demographics
NPI:1548257850
Name:GO, JAIME L (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:L
Last Name:GO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1434 HOMESTEAD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2582
Mailing Address - Country:US
Mailing Address - Phone:440-884-2126
Mailing Address - Fax:
Practice Address - Street 1:6315 PEARL RD
Practice Address - Street 2:STE 206
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3082
Practice Address - Country:US
Practice Address - Phone:440-884-2126
Practice Address - Fax:440-884-2127
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH47885208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0652600Medicaid
OHG00573112Medicare ID - Type Unspecified
OH0652600Medicaid