Individual
DR. JEREMY W HENRICHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
810 W. ANTHONY DRIVE, URBANA, IL 61801-7431
(217) 326-2255
(217) 326-0210
Mailing address
PO BOX 6002, URBANA, IL 61803-6002
(217) 326-8630
(217) 379-2604
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
03611190
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111690
—
IL
Enumeration date
06/20/2005
Last updated
05/22/2013
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