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General NPI Number Information
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NPI Number | 1376578005
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Entity Type | Individual
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Provider Name | YIHOODAH Y GREEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 2128 S CENTRAL PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60623-3113
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Country | US
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Telephone | 773-467-6967
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Fax | 773-572-9553
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Provider Business Mailing Address
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Address Line | 1022 N KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60651-4128
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Country | US
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Telephone | 773-467-6967
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Fax | 773-572-9553
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036103929
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036103929
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License Number State | IL
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