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42505 Woodward Ave Ste 100 Bloomfield Hills MI 48304-5147 | |
| (248) 771-2800 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 42505 Woodward Ave Ste 100, Bloomfield Hills, Michigan |
| Authorized Official Name and Position | Jaime Lyn-essian Taylor (OWNER, MEDICAL DIRECTOR) |
| Authorized Official Contact | 2487712800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
42505 Woodward Ave Ste 100 Bloomfield Hills MI 48304-5147 Ph: (248) 771-2800 | 42505 Woodward Ave Ste 100 Bloomfield Hills MI 48304-5147 Ph: (248) 771-2800 |
| NPI Number | 1972363125 |
|---|---|
| Provider Enumeration Date | 03/21/2024 |
| Last Update Date | 01/08/2025 |
| Certification Date | 01/08/2025 |
| Medicare PECOS PAC ID | 6204368228 |
|---|---|
| Medicare Enrollment ID | O20241016000501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972363125 | NPI | - | NPPES |
| Provider Name | Jaime Lyn-essian Taylor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538471883 PECOS PAC ID: 2668613381 Enrollment ID: I20160726000870 |
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