Provider Demographics
NPI:1538550280
Name:YEMANE B BAHTA MD,PA
Entity type:Organization
Organization Name:YEMANE B BAHTA MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YEMANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-392-5696
Mailing Address - Street 1:PO BOX 260101
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-7101
Mailing Address - Country:US
Mailing Address - Phone:954-392-5696
Mailing Address - Fax:954-392-5668
Practice Address - Street 1:10794 PINES BLVD
Practice Address - Street 2:203
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3920
Practice Address - Country:US
Practice Address - Phone:954-392-5696
Practice Address - Fax:954-392-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71889207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252020600Medicaid