MEDICARE: MR. MARCIN T MIKA APRN, FPA, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277005224	IL

General Provider Information

NPI Number	:	1669734315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCIN T MIKA APRN, FPA, PMHNP-BC

Provider Business Mailing Address
First Line	:	33 W HIGGINS RD STE 655
Second Line	:
City	:	SOUTH BARRINGTON
State	:	IL
Zip	:	60010-9134
Country	:	US
Telephone Number	:	224-848-5253
Fax Number	:	224-848-5254

Provider Business Practice Location Address
First Line	:	33 W HIGGINS RD STE 655
Second Line	:
City	:	SOUTH BARRINGTON
State	:	IL
Zip	:	60010-9134
Country	:	US
Telephone Number	:	224-848-5253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2012
Last Update Date	:	03/26/2026

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