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
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