Provider Demographics
NPI:1578599510
Name:HENRIKSEN, LINDA CHRISTIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:CHRISTIE
Last Name:HENRIKSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:CHRISTIE
Other - Last Name:HENRIKSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4485
Mailing Address - Country:US
Mailing Address - Phone:312-218-1343
Mailing Address - Fax:
Practice Address - Street 1:8 CYPRESS CT
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4485
Practice Address - Country:US
Practice Address - Phone:312-218-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603353OtherBCBS
ILC49157Medicare UPIN
IL080151075Medicare PIN