Provider Demographics
NPI:1528154804
Name:HENRIKSEN, LINDA (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HENRIKSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 GROVEWAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-1122
Mailing Address - Country:US
Mailing Address - Phone:713-644-1568
Mailing Address - Fax:
Practice Address - Street 1:10701 VINTAGE PRESERVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:713-442-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32793409Medicaid
TX132793407Medicaid
TX132793408Medicaid
TX132793405Medicaid
TX132793408Medicaid
TX32793409Medicaid
TX8258B3Medicare PIN
TX132793405Medicaid