Basic Information
| Provider Information | |||||||||
| NPI: | 1033167226 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAMBAO | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1239 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480991239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488246600 | ||||||||
| FaxNumber: | 8556186655 | ||||||||
| Practice Location | |||||||||
| Address1: | 4444 W BRISTOL RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485073153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102309500 | ||||||||
| FaxNumber: | 8102300169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 07/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301076901 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010B560260 | 01 | MI | BCBSM | OTHER | 010B560260 | 01 | MI | BLUE CHOICE | OTHER | 080B513530 | 01 | MI | BLUE CARE NETWORK GROUP | OTHER | 010B560260 | 01 | MI | BLUE CARE NETWORK | OTHER | 0802511362 | 01 | MI | BLUE CROSS BLUE SHIELD IN | OTHER | 4743541 | 05 | MI | MEDICAID | 010B560260 | 01 | MI | COMMUNITY BLUE | OTHER | 1015329 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 080B513530 | 01 | MI | BLUE CROSS BLUE SHIELD GR | OTHER | 4891796 | 05 | MI | MEDICAID | H94308 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | 1015329 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | 0999611 | 01 | MI | HEALTHPLUS | OTHER |