Kenneth Craig Micetich, MD

Hematology & Oncology Physician · Maywood, IL

Individual Active NPI

NPI number 1619954583

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

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NPI record

NPI
1619954583
Entity type
Individual (Type 1)
Enumeration date
December 30, 2005
Last updated
January 6, 2010
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Hematology & Oncology Physician Primary 207RH0003X 36056032 IL

About Dr. Micetich

Kenneth Craig Micetich, MD is a healthcare provider registered in the NPI registry with the primary taxonomy Hematology & Oncology Physician (code 207RH0003X). The practice location is 2160 S 1st Ave, (15750 Marion Dr., Homer Glen, Il. 60491), Maywood, IL 60153-3328. The NPI number 1619954583 was assigned on December 30, 2005 and the record was last updated on January 6, 2010.

Dr. Micetich lists a license in the registry: #36056032 (IL) for Hematology & Oncology Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Kenneth Craig Micetich, MD?

The NPI number is 1619954583.

What is the phone number of Dr. Micetich?

The phone number listed for the practice location is (708) 645-3400.

Where is Dr. Micetich located?

2160 S 1st Ave, (15750 Marion Dr., Homer Glen, Il. 60491), Maywood, IL 60153-3328.

What is the taxonomy code for Dr. Micetich?

The primary taxonomy code is 207RH0003X – Hematology & Oncology Physician.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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