Provider Demographics
NPI:1235199704
Name:HENRIKSON, CHARLES A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:HENRIKSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:DIVISION OF CARDIOLOGY UHN 62
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8750
Mailing Address - Fax:503-494-8550
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:DIVISION OF CARDIOLOGY UHN 62
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8750
Practice Address - Fax:503-494-8550
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-09-16
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Provider Licenses
StateLicense IDTaxonomies
MDD0056584207RC0001X
ORMD155423207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI36604Medicare UPIN