Individual
DANIEL LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
1305 W AMERICAN DR, NEENAH, WI 54956-1993
(800) 201-1194
(920) 725-7392
Mailing address
1305 W AMERICAN DR, NEENAH, WI 54956-1993
(920) 725-9373
(920) 720-7392
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
5101020941
MI
2084N0400X
Neurology Physician
Primary
70781-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088599
—
WI
Enumeration date
06/16/2014
Last updated
10/25/2019
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