Henrichs, Jeremy W

Henrichs, Jeremy W is an individual health care provider with primary practice located at 810 W. Anthony Drive , Urbana IL 61801-7431. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Henrichs, Jeremy W can be contacted via phone (217) 326-2255.

Contact Information

Primary practice address
810 W. Anthony Drive Urbana IL 61801-7431
Phone: (217) 326-2255
Fax: (217) 326-0210
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 03611190 Illinois

Profile Details

NPI number 1154326759
LBN Legal business name Henrichs, Jeremy W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2005
Last updated May 22nd, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154326759 NPPES
Illinois MEDICAID 036111690

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