Provider Demographics
NPI:1851553762
Name:BAINES, JAMIE CHIONI
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:CHIONI
Last Name:BAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:CHIONI
Other - Last Name:BAINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:17251 W 12 MILE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2140
Mailing Address - Country:US
Mailing Address - Phone:248-331-1700
Mailing Address - Fax:248-331-1701
Practice Address - Street 1:1109 W LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1967
Practice Address - Country:US
Practice Address - Phone:248-723-2400
Practice Address - Fax:248-723-5785
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019087207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine