Provider Demographics
NPI:1215152210
Name:LINDA HENRIKSEN, M.D.,S.C.
Entity type:Organization
Organization Name:LINDA HENRIKSEN, M.D.,S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, SC
Authorized Official - Phone:773-763-1344
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE #327
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-763-1344
Mailing Address - Fax:773-763-4313
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE #327
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-763-1344
Practice Address - Fax:773-763-4313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL080151075OtherRAILROAD MEDICARE
IL31603353OtherBLUE CROSS BLUE SHIELD
IL080151075OtherRAILROAD MEDICARE