Healthcare Provider Details

I. General information

NPI: 1285721415
Provider Name (Legal Business Name): JAIME B YAMAT MDSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 W INNOVATION DR STE 700
MILWAUKEE WI
53226-4827
US

IV. Provider business mailing address

1001 W GLEN OAKS LN SUITE 105
MEQUON WI
53092-3365
US

V. Phone/Fax

Practice location:
  • Phone: 414-302-9196
  • Fax:
Mailing address:
  • Phone: 414-365-3210
  • Fax: 414-365-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAIME B YAMAT
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 414-384-2700