Provider Demographics
NPI:1245440130
Name:BEDFORD, JAIME LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:LYNN
Last Name:BEDFORD
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Gender:F
Credentials:MD
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Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:STE 221
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-685-8050
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:220 JEFFERSON SE
Practice Address - Street 2:5TH FLOOR ICU
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-685-5000
Practice Address - Fax:616-685-1850
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2008-12-30
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Provider Licenses
StateLicense IDTaxonomies
MI4301080207208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP32930283Medicare PIN