Micetich, Keith A
Micetich, Keith A is an individual health care provider with primary practice located at 72 Physicians Dr , Jackson TN 38305-2070. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Micetich, Keith A can be contacted via phone (731) 668-4455.Contact Information
Primary practice address
72 Physicians Dr
Jackson TN 38305-2070
Phone: (731) 668-4455
Fax: (731) 668-9007
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 26274 | Tennessee |
Profile Details
| NPI number | 1427026137 |
|---|---|
| LBN Legal business name | Micetich, Keith A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 9th, 2006 |
| Last updated | Nov 2nd, 2011 - about 13 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1427026137 | NPPES |
| Tennessee | Other | 3009628 | BLUE CROSS BLUE SHIELD |
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