Individual
DR. HENRIK B ILLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1615 HOSPITAL PARKWAY, SUITE 300, BEDFORD, TX 76022
(817) 354-5581
(817) 359-9062
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
N0118
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194728503
—
TX
01
—
P01449276
RAILROAD MEDICARE
TX
Enumeration date
05/29/2007
Last updated
06/25/2015
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