Individual
LUKE THOMAS HENTRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1421 COLOMBO DR, HERRIN, IL 62948-4402
(618) 364-5576
Mailing address
1421 COLOMBO DR, HERRIN, IL 62948-4402
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
S12740
AL
Other
Enumeration date
01/23/2020
Last updated
01/23/2020
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