Individual
MR. TIMOTHY J MICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3964 GOODMAN RD E, SUITE 128, SOUTHAVEN, MS 38672-8761
(662) 420-7350
(662) 874-5214
Mailing address
3964 GOODMAN RD, STE 128, SOUTHAVEN, MS 38672-6494
(662) 420-7350
(662) 874-5214
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
23185
MS
207X00000X
Orthopaedic Surgery Physician
64863
GA
207X00000X
Orthopaedic Surgery Physician
MD0000045338
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01988867
—
MS
Enumeration date
11/01/2006
Last updated
07/10/2017
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