Organization
LAURA L. LONG M.D., S.C.
Active
Organization
LAURA L. LONG M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURA LYNN LONG M.D. (PRESIDENT)
(312) 882-9119
Entity
Organization
Contact information
Practice address
122 S MICHIGAN AVE, SUITE 1406, CHICAGO, IL 60603-6191
(312) 882-9119
(312) 663-3796
Mailing address
122 S MICHIGAN AVE, SUITE 1406, CHICAGO, IL 60603-6191
(312) 882-9119
(312) 663-3796
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036114793
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518012590
NPI
—
Enumeration date
03/26/2009
Last updated
03/26/2009
Update your record
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