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Dr. Keith A Micetich, MD
Specialist in Jackson, Tennessee
NPI 1427026137

Keith A Micetich is a Specialist based in Jackson, TN. Keith A Micetich practices in Jackson, TN and has the professional credentials of MD. The NPI Number for Keith A Micetich is 1427026137 and holds a License No. 26274 (Tennessee).

The current practice location address for Keith A Micetich is 72 Physicians Dr, Jackson, TN and can be reached out via phone at 731-668-4455 and via fax at 731-668-9007.

Location: 72 Physicians Dr, Jackson, TN, 38305-2070
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1427026137
Provider Name
Keith A Micetich
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
72 Physicians Dr, Jackson, TN, 38305-2070
Phone Number
731-668-4455
Fax Number
731-668-9007
Provider Enumeration Date
03/09/2006
Last Update Date
03/08/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
3009628 01 TN BLUE CROSS BLUE SHIELD
institution
Provider Business Practice Location Address Details
Address
72 Physicians Dr
City
Jackson
State
Tennessee
Zip
38305-2070
Phone Number
731-668-4455
Fax Number
731-668-9007
person
Provider Business Mailing Address Details
Address
72 Physicians Dr
City
Jackson
State
Tennessee
Zip
38305-2070
Phone Number
731-668-4455
Fax Number
731-668-9007
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
26274 (Tennessee)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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