Micetich, Kenneth Craig

Micetich, Kenneth Craig is an individual health care provider with primary practice located at 2160 S 1St Ave (15750 Marion Dr., Homer Glen, Il. 60491), Maywood IL 60153-3328. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hematology & Oncology, which is considered as his primary health care specialty. Micetich, Kenneth Craig can be contacted via phone (708) 645-3400.

Contact Information

Primary practice address
2160 S 1St Ave (15750 Marion Dr., Homer Glen, Il. 60491) Maywood IL 60153-3328
Phone: (708) 645-3400
Fax: (708) 645-3411
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hematology & Oncology 207RH0003X 36056032 Illinois

Profile Details

NPI number 1619954583
LBN Legal business name Micetich, Kenneth Craig
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 30th, 2005
Last updated Jan 6th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619954583 NPPES
Illinois MEDICAID 36056032

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