Provider Demographics
NPI:1376774372
Name:BAYLOCK, JAIME S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:S
Last Name:BAYLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAIME
Other - Middle Name:N
Other - Last Name:SUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19550 GOVERNORS HWY
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2125
Mailing Address - Country:US
Mailing Address - Phone:708-957-8750
Mailing Address - Fax:
Practice Address - Street 1:19550 GOVERNORS HWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2125
Practice Address - Country:US
Practice Address - Phone:708-957-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-128942207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-128942OtherSTATE LICENSE NUMBER
IL125056222OtherSTATE LICENSE NUMBER