Basic Information
| Provider Information | |||||||||
| NPI: | 1285721415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAIME B YAMAT MDSC | ||||||||
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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: | 10/09/2006 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | YAMAT | ||||||||
| AuthorizedOfficialFirstName: | JAIME | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4143842700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 30896100 | 05 | WI | MEDICAID |