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Organization
MICHIGAN INFUSION AND LICENSED HEALTHCARE
Active
Organization
MICHIGAN INFUSION AND LICENSED HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY L LONG PA-C (OWNER/MANAGER)
(734) 341-7767
Entity
Organization
Contact information
Practice address
500 ROSS ST, PLYMOUTH, MI 48170-2206
(734) 341-7767
Mailing address
500 ROSS ST, PLYMOUTH, MI 48170-2206
(734) 341-7767
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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