Healthcare Provider Details

I. General information

NPI: 1992736383
Provider Name (Legal Business Name): TRISHA MIKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 ELM ST
WINNETKA IL
60093-2556
US

IV. Provider business mailing address

716 ELM ST
WINNETKA IL
60093-2556
US

V. Phone/Fax

Practice location:
  • Phone: 847-501-4040
  • Fax: 847-501-4075
Mailing address:
  • Phone: 847-501-4040
  • Fax: 847-501-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036097125
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: