Provider Demographics
NPI:1760839187
Name:REJCEK, MICAH (DO)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:REJCEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17TH MEDICAL GROUP
Mailing Address - Street 2:271 FT RICHARDSON AVE
Mailing Address - City:GOODFELLOW AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76908
Mailing Address - Country:US
Mailing Address - Phone:325-654-3634
Mailing Address - Fax:
Practice Address - Street 1:17TH MEDICAL GROUP
Practice Address - Street 2:271 FT RICHARDSON AVE
Practice Address - City:GOODFELLOW AFB
Practice Address - State:TX
Practice Address - Zip Code:76908
Practice Address - Country:US
Practice Address - Phone:325-654-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1723171000000X, 171000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty