Healthcare Provider Details

I. General information

NPI: 1700370277
Provider Name (Legal Business Name): MEGHA TRIVEDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S MICHIGAN AVE
CHICAGO IL
60605-2810
US

IV. Provider business mailing address

1411 S MICHIGAN AVE
CHICAGO IL
60605-2810
US

V. Phone/Fax

Practice location:
  • Phone: 312-454-2710
  • Fax: 312-942-7778
Mailing address:
  • Phone: 312-454-2710
  • Fax: 312-942-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301115201
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036.160218
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: