Individual
BETHANY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4123 MARTIN RD STE 102, COMMERCE TOWNSHIP, MI 48390-4151
(248) 366-3700
(248) 366-1038
Mailing address
24 FRANK LLOYD WRIGHT DR STE J2000, ANN ARBOR, MI 48105-9484
(734) 747-6766
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601013144
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/25/2024
Last updated
05/28/2025
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