Provider Demographics
NPI:1538471883
Name:TAYLOR, JAIME LYN-ESSIAN (DO)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYN-ESSIAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYN
Other - Last Name:ESSIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1777 AXTELL DR STE 202
Practice Address - Street 2:HOUGH CENTER FOR ADOLESCENT DISORDERS - BEAUMONT
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4435
Practice Address - Country:US
Practice Address - Phone:248-594-3142
Practice Address - Fax:248-594-3249
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004262A207Q00000X
MI510018666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine