Provider Demographics
NPI:1356347264
Name:ECHIVERRI, HENRY C (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:C
Last Name:ECHIVERRI
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 1:3S 517 WINFIELD RD
Mailing Address - Street 2:STE A
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3159
Mailing Address - Country:US
Mailing Address - Phone:630-836-9121
Mailing Address - Fax:630-836-9126
Practice Address - Street 1:3S 517 WINFIELD RD
Practice Address - Street 2:STE A
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3159
Practice Address - Country:US
Practice Address - Phone:630-836-9121
Practice Address - Fax:630-836-9126
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360752022084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075202Medicaid
IL036075202OtherSTATE LICENSE
IL036075202Medicaid
K08814Medicare ID - Type Unspecified