Healthcare Provider Details

I. General information

NPI: 1851553762
Provider Name (Legal Business Name): JAMIE CHIONI BAINES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE CHIONI BAINES DO

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28595 ORCHARD LAKE RD STE 104
FARMINGTON HILLS MI
48334-2978
US

IV. Provider business mailing address

28595 ORCHARD LAKE RD STE 104
FARMINGTON HILLS MI
48334-2978
US

V. Phone/Fax

Practice location:
  • Phone: 248-965-0541
  • Fax: 810-487-4854
Mailing address:
  • Phone: 248-965-0541
  • Fax: 810-487-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5101019087
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101019087
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: