Individual
BENJAMIN S LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1465 E PARKDALE AVE, MANISTEE, MI 49660-9709
(231) 398-1000
Mailing address
4100 EMBASSY DR SE STE 400, GRAND RAPIDS, MI 49546-2416
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301119307
MI
Other
Enumeration date
06/30/2017
Last updated
06/29/2020
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