| Doctor Name: | LISA MARIE MICETICH |
| NPI Number: | 1568682284 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.D. |
| License Number: | |
| Business Practice Address: | 2800 W 95th St Evergreen Park, IL - 608052701 |
| Business Phone Number: | 7082295429 |
| Business Fax Number: | 7082295308 |
| Mailing Address: | 9015 Witham Ln, WOODRIDGE |
| State: | IL |
| Postal Code: | 605177621 |
| Phone Number: | 7082295429 |
| Fax Number: | 7082295308 |
| NPI Enumeration Date: | 04/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |