Provider Demographics
NPI:1669435756
Name:HENRIKSON, TODD KARL (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:KARL
Last Name:HENRIKSON
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 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:500 OSBORNE RD NE
Practice Address - Street 2:SUITE 255
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2765
Practice Address - Country:US
Practice Address - Phone:763-236-2500
Practice Address - Fax:763-236-2505
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44189207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6605861OtherMEDICA UC
MN0405569OtherMEDICA
MN1834677OtherAMERICA'S PPO
MN7548493OtherAETNA
MN786120600Medicaid
MNHP38794OtherHEALTHPARTNERS
MN171482OtherUCARE MN
MN375J5HEOtherBCBS OF MN
MN1034375OtherPREFERRED ONE
MNH400126734Medicare PIN
MN375J5HEOtherBCBS OF MN
MN1834677OtherAMERICA'S PPO