Individual
MICHAEL J LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1640 E SUMNER ST, HARTFORD, WI 53027-2684
(262) 670-4000
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32332
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31752100
—
WI
Enumeration date
02/07/2006
Last updated
03/29/2023
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