MEDICARE: YIHOODAH Y GREEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036103929	IL
2	2084P0800X	Psychiatry Physician	036103929	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376578005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YIHOODAH Y GREEN M.D.

Provider Business Mailing Address
First Line	:	1022 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-4128
Country	:	US
Telephone Number	:	773-467-6967
Fax Number	:	773-572-9553

Provider Business Practice Location Address
First Line	:	2128 S CENTRAL PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3113
Country	:	US
Telephone Number	:	773-467-6967
Fax Number	:	773-572-9553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/25/2024

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