KENNETH CRAIG MICETICH MD
NPI 1619954583
Internal Medicine - Hematology & Oncology in Maywood, IL

Q: What is Kenneth Micetich's NPI number?

The NPI number for Kenneth Micetich is 1619954583. It was assigned to this individual provider in the NPPES registry on December 30, 2005.

Q: What is Kenneth Micetich's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Hematology & Oncology, with taxonomy code 207RH0003X.

Q: When was this NPI record last updated?

The NPPES record for Kenneth Micetich was last updated on January 6, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 30, 2005PECOS Enrolled

2160 S 1ST AVE, (15750 MARION DR., HOMER GLEN, IL. 60491), MAYWOOD, IL 60153(708) 645-3400(708) 645-3411 Get Directions Write a Review

NPPES record last updated: January 6, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Kenneth Craig Micetich Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH CRAIG MICETICH MD (NPI 1619954583) is an individual hematology & oncology provider in Maywood, Illinois, licensed in Illinois (36056032) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619954583

Entity TypeIndividualMale

Primary Taxonomy207RH0003X

Provider Legal NameKENNETH CRAIG MICETICHCredential: MD

Location Address2160 S 1ST AVE, (15750 MARION DR., HOMER GLEN, IL. 60491)Maywood, IL 60153-3328

Mailing Address2160 S 1st Ave, (15750 Marion Dr., Homer Glen, Il. 60491)Maywood, IL 60153-3328 · (708) 645-3400 · Fax (708) 645-3411

Phone(708) 645-3400

Fax(708) 645-3411

Sole ProprietorNo

Enumeration DateDecember 30, 2005

Last NPPES UpdateJanuary 6, 2010

✔ NPI 1619954583 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Hematology & OncologyAllopathic & Osteopathic Physicians

Taxonomy Code207RH0003X

License✔ Licensed in IL · 36056032

Definition

An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

2160 S 1ST AVE, Maywood, IL 60153

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Other Identifiers 3

Medicare UPINC45421

Medicare ID-Type Unspecified673210IL

Medicaid36056032IL

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenneth Craig Micetich Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60153 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$183.39 typical visit price

range $60.08 – $183.39

Typical copayment $45.84 (range $15.02 – $45.84)

Most-billed visit code 99205

Established Patient

$105.70 typical visit price

range $18.97 – $148.12

Typical copayment $26.42 (range $4.74 – $37.03)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Capecitabine, oral, 500 mg J8521

Treatment-Treatment - Miscellaneous · category RX029N

2 suppliers12 claims1,056 services$0.60 avg. paid by Medicare

Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period Q0512

Treatment-Chemotherapy · category RH012N

2 suppliers12 claims12 services$11.68 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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