Healthcare Provider Details

I. General information

NPI: 1467660779
Provider Name (Legal Business Name): JAIME LYNN DREYER-LAEZZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44199 DEQUINDRE RD SUITE 222
TROY MI
48085-1128
US

IV. Provider business mailing address

633 SOUTH BLVD E STE 2400
ROCHESTER HILLS MI
48307-5471
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-5570
  • Fax:
Mailing address:
  • Phone: 248-879-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301087960
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: