Individual
KATHLEEN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2070 BIDDLE AVE STE 2, WYANDOTTE, MI 48192-4080
(734) 225-9100
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011817
MI
Other
Enumeration date
06/22/2022
Last updated
03/07/2025
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