Individual
MR. KEVIN M HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 416, PEORIA, IL 61614-5098
(309) 692-7246
(309) 692-7226
Mailing address
5401 N KNOXVILLE AVE, SUITE 416, PEORIA, IL 61614-5098
(309) 692-7246
(309) 692-7226
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036114669
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036114669
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
10492
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114669
—
IL
Enumeration date
01/09/2006
Last updated
01/10/2013
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