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General NPI Number Information
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NPI Number | 1831115252
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Entity Type | Individual
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Provider Name | ADAMINAH KHEPHZIBAH BAHT-YEHUDAH PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 500 E 51ST ST
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City | CHICAGO
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State | IL
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Zip | 60615-2400
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Country | US
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Telephone | 312-572-1089
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Fax | 312-572-1294
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Provider Business Mailing Address
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Address Line | 8056 S ESSEX AVE
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City | CHICAGO
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State | IL
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Zip | 60617-1221
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Country | US
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Telephone | 773-978-0072
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | IL
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