Individual
DOUGLAS K HENSTROM
Active
Individual
DOUGLAS K HENSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
39672
IA
207Y00000X
Otolaryngology Physician
47669
MN
207YS0123X
Facial Plastic Surgery Physician
39672
IA
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
10222796-1205
UT
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
39672
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
767689100
—
MN
Enumeration date
02/07/2006
Last updated
04/11/2017
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