Kenneth Craig Micetich, MD
Internal Medicine, Hematology & Oncology in Maywood, IL. Individual provider (NPI-1).
NPI number1619954583
StatusActive
Last updated in NPPESJan 6, 2010
Details
- NPI
- 1619954583
- Entity type
- Individual (NPI-1)
- Name
- Kenneth Craig Micetich
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 30, 2005
- Last updated
- Jan 6, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RH0003X | Internal Medicine, Hematology & Oncology | 36056032 | IL | Yes |
Practice location
2160 S 1st Ave(15750 Marion Dr., Homer Glen, Il. 60491)
Maywood, IL 60153-3328
Phone 708-645-3400 · Fax 708-645-3411
Mailing address
2160 S 1st Ave(15750 Marion Dr., Homer Glen, Il. 60491)
Maywood, IL 60153-3328
Phone 708-645-3400 · Fax 708-645-3411
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