Basic Information
| Provider Information | |||||||||
| NPI: | 1134174386 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YAMAT | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W GLEN OAKS LN | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530923365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143653210 | ||||||||
| FaxNumber: | 4143652937 | ||||||||
| Practice Location | |||||||||
| Address1: | 10200 W INNOVATION DR STE 700 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143029196 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 19242 | WI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 30896100 | 05 | WI | MEDICAID |