1033167226 NPI number — JAIME T YAMBAO MD

Table of content: JAIME T YAMBAO MD (NPI 1033167226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033167226 NPI number — JAIME T YAMBAO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAMBAO
Provider First Name:
JAIME
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033167226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48099-1239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-824-6600
Provider Business Mailing Address Fax Number:
855-618-6655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4444 W BRISTOL RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48507-3153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-230-9500
Provider Business Practice Location Address Fax Number:
810-230-0169
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301076901 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010B560260 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 010B560260 . This is a "BLUE CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080B513530 . This is a "BLUE CARE NETWORK GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 010B560260 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0802511362 . This is a "BLUE CROSS BLUE SHIELD IN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4743541 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010B560260 . This is a "COMMUNITY BLUE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1015329 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080B513530 . This is a "BLUE CROSS BLUE SHIELD GR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4891796 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: H94308 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1015329 . This is a "HEALTH ADVANTAGE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0999611 . This is a "HEALTHPLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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