Provider Demographics
NPI:1033524590
Name:HAJJARI, JAIME R (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:R
Last Name:HAJJARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3640 NEW VISION DR STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1717
Mailing Address - Country:US
Mailing Address - Phone:260-482-4440
Mailing Address - Fax:260-482-4442
Practice Address - Street 1:1260 E STATE ROAD 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725
Practice Address - Country:US
Practice Address - Phone:260-248-9000
Practice Address - Fax:260-482-4442
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01078402A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001082449OtherANTHEM
IN300001694Medicaid