Provider Demographics
NPI:1174669550
Name:COVELLI, HENRY D (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:D
Last Name:COVELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3727
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-2529
Mailing Address - Country:US
Mailing Address - Phone:866-805-0885
Mailing Address - Fax:
Practice Address - Street 1:600 N CECIL RD
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6200
Practice Address - Country:US
Practice Address - Phone:208-262-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5790207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002128000Medicaid
ID002128000Medicaid
IDB29147Medicare UPIN