Basic Information
| Provider Information | |||||||||
| NPI: | 1619908662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENRICHS | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 W. PARK ST. | ||||||||
| Address2: | BWPC | ||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173836792 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 HEATHER DRIVE | ||||||||
| Address2: | |||||||||
| City: | MAHOMET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175868400 | ||||||||
| FaxNumber: | 2175865093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 02/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036110917 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.