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:
Health care specialties
Specialty | Code | License # | 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 15 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 | 1619954583 | NPPES |
Illinois | MEDICAID | 36056032 |
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