Provider Demographics
NPI:1265078497
Name:JAIME L GO MD INC
Entity type:Organization
Organization Name:JAIME L GO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:L
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-884-2126
Mailing Address - Street 1:1434 HOMESTEAD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2582
Mailing Address - Country:US
Mailing Address - Phone:440-884-2126
Mailing Address - Fax:
Practice Address - Street 1:1200 RESOURCE DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN HTS
Practice Address - State:OH
Practice Address - Zip Code:44131-1849
Practice Address - Country:US
Practice Address - Phone:440-884-2126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty