Provider Demographics
NPI:1134174386
Name:YAMAT, JAIME B (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:B
Last Name:YAMAT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1001 W GLEN OAKS LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3365
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-2937
Practice Address - Street 1:10200 W INNOVATION DR STE 700
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4827
Practice Address - Country:US
Practice Address - Phone:414-302-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2022-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI19242207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30896100Medicaid
WI30896100Medicaid
WI000101555Medicare PIN