Individual
GLENN C HENRIKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-5520
Mailing address
541 OTIS BOWEN DR, MUNSTER, IN 46321-4158
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036063101
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063101
—
IL
Enumeration date
12/05/2005
Last updated
05/27/2008
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