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 1:28595 ORCHARD LAKE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2978
Mailing Address - Country:US
Mailing Address - Phone:248-965-0541
Mailing Address - Fax:810-487-4854
Practice Address - Street 1:28595 ORCHARD LAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2978
Practice Address - Country:US
Practice Address - Phone:248-965-0541
Practice Address - Fax:810-487-4854
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019087207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine