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General NPI Number Information
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NPI Number | 1033167226
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Entity Type | Individual
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Provider Name | JAIME T YAMBAO MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 4444 W BRISTOL RD SUITE 150
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City | FLINT
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State | MI
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Zip | 48507-3153
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Country | US
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Telephone | 810-230-9500
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Fax | 810-230-0169
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Provider Business Mailing Address
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Address Line | PO BOX 1239
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City | TROY
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State | MI
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Zip | 48099-1239
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Country | US
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Telephone | 248-824-6600
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Fax | 855-618-6655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301076901
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License Number State | MI
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