Healthcare Provider Details

I. General information

NPI: 1588346779
Provider Name (Legal Business Name): EMMA FAITH CHEATHAM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK ST STE 3230
ELMHURST IL
60126-5629
US

IV. Provider business mailing address

4901 SEARLE PKWY STE 150
SKOKIE IL
60077-5320
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6020
  • Fax: 630-527-3400
Mailing address:
  • Phone: 847-733-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085010674
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: