Individual
LISA MARIE MICETICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
2800 W 95TH ST, EVERGREEN PARK, IL 60805-2701
(708) 229-5429
(708) 229-5308
Mailing address
9015 WITHAM LN, WOODRIDGE, IL 60517-7621
(708) 229-5429
(708) 229-5308
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
IL
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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