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General NPI Number Information
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NPI Number | 1366441362
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Entity Type | Individual
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Provider Name | BRIAN A HENJUM MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 12/31/2008
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Provider Practice Location Address
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Address Line | 13560 WAYZATA BLVD
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City | MINNETONKA
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State | MN
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Zip | 55305-1850
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Country | US
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Telephone | 763-257-8100
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Fax | 763-257-8140
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Provider Business Mailing Address
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Address Line | 4695 SHORELINE DR
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City | SPRING PARK
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State | MN
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Zip | 55384-9715
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Country | US
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Telephone | 952-442-7890
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Fax | 952-442-7893
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26247
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License Number State | MN
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